There is promising evidence that Pilates can improve body composition for patients with obesity.

Physical activity is a long-recognized strategy and recommendation for weight loss and maintaining a healthy weight. When we think of physical activity in the context of weight loss, our minds tend to drift to high-intensity aerobic exercises such as jogging, cycling, or swimming or perhaps even weight training, all of which are empirically supported strategies for weight loss.¹ For persons with obesity, these more intense exercise programs may not initially be practical, particularly for those who have been sedentary and are in the early stages of integrating increased physical activity into their weight management program.

For those patients with obesity who are beginning to add exercise to their weight loss program, an alternative exercise program that offers adaptable forms of movement and no stress on joints could help them build confidence and keep them motivated in the early stages. One such approach to exercise is Pilates.² Pilates is a low-impact form of exercise that allows beginners to gradually increase cardiovascular and muscular fitness. There is growing evidence to suggest Pilates can improve body composition, but more research is needed on its benefits to cardiometabolic health.²

For patients with obesity, a Pilates program can help them ease into a more active lifestyle while minimizing the risk of injury associated with exercise programs that are more taxing on joints.

Understanding Pilates and how it can Add Value to Weight Loss Programs

A Pilates program engages minds and bodies as it focuses on increasing muscle control, improving posture, and improving breathing.² Pilates works muscles without fully fatiguing them, and many of the exercises can be done without special equipment, though specialized equipment can be found at Pilates studios or local gyms.

Patients with obesity can get started with a mat to perform exercises that involve lying down. However, exercises can be adapted based on any physical limitations a patient may have early on. Pilates is generally considered to be a therapeutic or rehabilitative form of exercise because it focuses on improving physical fitness through movements that improve lower back pain, posture, movement dysfunction, musculoskeletal health, and poor functional capacity.²

Pilates, Body Composition and Cardiometabolic Health

A recent review² examined studies published between 2006 and 2020 (N = 14) to investigate how Pilates affects body composition, cardiometabolic health, and physical fitness. Of the 14 studies included in the review, 12 were categorized as floor-based (i.e., participants used a mat) and two were classified as specialized equipment-based. The training studies included Pilates interventions for four to 24 weeks, and the Pilates sessions ranged from three to five times per week. The most used Pilates protocol across the 14 studies was a mat-based intervention that included three sessions per week for 60 minutes per session. Thirteen of the Pilates interventions were supervised, and one was semi-supervised. Data was collected from 582 participants across all studies. Results suggest that Pilates improved body composition but no evidence for cardiometabolic health was found.

Participants yielded the greatest benefits in body weight, BMI, and waist size. No effects of lean body mass were found. The authors of the review report that participating in Pilates three times per week for 60 minutes yields optimal benefits. Previous research³ has found that multicomponent exercise programs that include aerobic and strength training have had positive effects on glucose, lipid metabolism, and blood pressure. This review did not find similar support for Pilates alone. The authors note that more research is needed in populations of patients with obesity who have been leading sedentary lifestyles so that comparative efficacy of different exercise programs can more fully explored.

It is important to note that the authors acknowledge the limitations of their review, most notably the small number of available studies that investigated Pilates as an intervention for patients with obesity. More research is needed to fully understand the efficacy of Pilates training for patients with obesity. It should also be noted that evidence from this review suggests Pilates is a viable form of exercise because of its positive effect on body composition.

While more work remains to be done, health care professionals should still consider talking with their patients about starting a Pilates exercise program. Pilates is an adaptable, low-impact form of exercise that can limit the risk of injury for previously sedentary patients as they begin their transition to a more physically active lifestyle. Pilates in conjunction with a medically-supervised Low Calorie Diet (LCD) or Very Low Calorie Diet (VLCD) can help give patients the confidence they need to continue their weight loss journey and lead a healthier lifestyle.

Sources:

1 Regional comparisons: the worldwide survey of fitness trends

2 Psychophysiological adaptations to Pilates Training in overweight and obese individuals: A topical review

3 Comparative efficacy of 5 exercise types on cardiometabolic health in overweight and obese adults: a systematic review and network meta-analysis of 81 randomized controlled trials