Ula Chambers<[log in to unmask]> writes:

<< .......In all the recent and past discussions on Pilates, core stability
training, versus weight training or no exercise for the treatment of chronic
back pain, it has been interesting to note that there has been no mention of
patients beliefs, leanings and preferences. Or am I being naive and this is a
"given"?

For all the evidence that exists to support one type of training above
another method, if the patient doesn't buy into it then it will not be
effective. Whereas, for example, one type of patient may be happy to go home
and practice whatever exercises they are given to "fix" their current
problem, others may benefit from the education, motivation and support that
group sessions can offer, be it Pilates, Yoga or aerobics classes
depending on age, taste and values.>

*** This is a most valid point, particularly since patient compliance is an
integral part of the overall rehabilitation regime.  However, even if the
patient does not "buy into" a given form of therapy, it may be that this
specific therapy is essential and has to be done.  As a cardiac
rehabilitation patient not too long ago, I can tell you that some forms of
therapy appeared to be infinitely boring or painful, but education as to
their necessity induced me to comply very strongly.  Though enjoyment of a
given form of therapy can enhance any given form of therapy, absence of such
enjoyment does not mean that this therapy will be ineffectual - probably just
less effectual. Sometimes the enjoyment and belief in the therapy may,
through the placebo effect, play the dominating role in that therapy, so,
yes, it is far more desirable to implement a system of therapy that
interests, challenges or pleases the patient as much as possible.

<Scientific training requires us to be methodical, analytical and critical
but above all open minded. Whereas the biopsychosocial approach demands we
put our evidence into the context of people's lives. I agree with Mel that
health clubs have their proportion of "old timers" who have trained with
weights for decades, however that does not mean to say that Pilates is not
effective for people who feel uncomfortable in a gym, or because fewer people
attend Pilates classes that this a reflection on the worth of the system.
People were suspicious of Yoga in the 1960s when it started becoming popular
in the west - yet we now agree that it promotes body awareness and
flexibility in people of all ages. Our end goal surly must be to improve the
patients pain and function, and this must be done co-operatively with the
individual concerned within their life context.>

*** With any form of therapy, I certainly would not stipulate an either-or
choice between two or more different types, unless a specific form definitely
was contraindicated for a given condition.  Thus, one might indeed combine
elements of Pilates with weight training or aerobics.  In fact, this sort of
approach is quite common in sports conditioning and is often referred to as
"complex" training, in which several different modalities are used at
different stages in the long-term program.  Thus, aerobic training would be
used for enhancing cardiovascular endurance; high repetition moderate weights
or machines may be used for developing local muscle endurance or hypertrophy;
'plyometric' training may be used for explosive strength and speed; and heavy
low repetition free weight training may be used for developing maximum
strength and power.  Somewhere in that plan one might even include hatha
yoga, Pilates, PNF-derived exercises, Tae Bo, martial arts, gymnastics,
swimming or other adjunct sports.

The effectiveness of such a programme depends not simply on a given single
modality, but on the integrated (or "conjugated") and carefully timed use of
all of those modalities, using their particular merits when most appropriate.
 For example, aerobic training generally would be discouraged during the
period when a sprinter needs to develop speed, power and agility; maximal
strength training would not be appropriate in the main aerobic part of the
season; and local muscle endurance training would not be appropriate during
the phases which focuses on maximal strength and power.

An understanding of the fundamental physiology and biomechanics involved
shows that Pilates training would not be the most effective for developing
maximum strength, cardiovascular endurance, maximum power, high levels of
flexibility-strength, speed or 'functional' agility, so it would not be used
for developing such fitness qualities, except possibly during their
preliminary stages.  Its use would then be matched by the instructor or
therapist to achieve certain goals at certain times, but it should never be
assumed that this style of training is a Jack of All Therapeutic and
Conditioning Trades.

Pilates, like aerobics and weight training, has a place and a time for its
optimal use, so it is misleading and unwarranted to declare its equality to
or universal superiority over other approaches in all situations.
Therefore, it is incorrect to maintain that Pilates offers a superior form of
strength, power, speed, heavily loaded agility and flexibility-strength
training to free weight training.  It was not designed for those purposes,
so, if these higher level conditioning needs are to be met (especially for
competitive athletes or manual labourers), then its use has to be augmented
with other modalities and techniques.  However, it undoubtedly has some use
as form of moderately effective musculoskeletal conditioning for the general
public or for the early stages of rehabilitation, but to regard it as a
universal conditioning system for higher levels of overall "fitness" and
sporting prowess, is inappropriate.  Its methods, machines and movement
patterns simply are not designed for those purposes.

Another factor that has to be taken into account is how effective a given
modality is in terms of time and effort to produce a given result.  Patient
compliance also relates to the amount of time, effort and complexity required
to carry out a specific therapeutic regime.

Finally, lest anyone suggests that I need to learn what Pilates really is
before I comment any further, I need to stress that I actually did attend a
Pilates instructors' course in my adventurous youth!  Similarly, I also
attended classes or workshops in several different forms of yoga, Alexander,
Feldenkrais, Laban and Barteniev fundamentals, simply because it is not my
habit to comment on anything about which I haven't the slightest knowledge.
My background also includes a competitive career in "Olympic" weightlifting,
powerlifting, martial arts, trampolining, track & field, as well as the usual
more British type university sports (I loved cricket!).  In addition I taught
"aerobics" for many years.

I have a debt to every one of these disciplines and therefore, I shall never
proclaim the universal superiority of any of them in all situations for all
people at all times, especially if some client hates one of them!  In fact,
anyone's ability to use any of these disciplines probably is enhanced more by
knowing what each one of them CANNOT do (or cannot optimally do) than what
each CAN do for a given client in a given situation.

Dr Mel C Siff
Denver, USA
http://groups.yahoo.com/group/Supertraining/