Pilates

Is Pilates a cardiovascular exercise? Does it improve the efficiency of cardiovascular training?

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Research Review with Dr.Brent Anderson

Can Pilates genuinely improve cardiorespiratory fitness?

A systematic review and meta-analysis published in the Journal of Clinical Medicine set out to answer that question by pooling data across 10 studies evaluating the method’s impact on maximal oxygen uptake (VO2Max). While the authors concluded that Pilates produces significant, moderate improvements in cardiorespiratory capacity across healthy and clinical cohorts alike, looking under the hood of the review reveals important nuances that every movement educator and clinician should understand before interpreting these findings as an aerobic prescription.

From a quality perspective, the underlying evidence base remains modest and diverse. Methodological quality tools, including the Cochrane RoB 2.0 tool for randomized controlled trials and the Quality Assessment Tool for Quantitative Studies for non-randomized trials, identified a mixed risk of bias, with common limitations around participant blinding and allocation concealment. Furthermore, the 10 included studies synthesized data from just 332 total participants across varied demographics, ranging from sedentary older adults and individuals recovering from stroke or heart failure to trained runners.

Crucially, several confounding variables warrant careful interpretation. A notable portion of the positive effect was driven by trials that combined Pilates with concurrent running or explicit aerobic exercise, introducing significant synergistic training effects rather than isolating Pilates mechanics alone. Measurement techniques also varied widely, mixing direct cardiopulmonary gas analysis with indirect submaximal heart rate or walking estimates. Because none of the analyzed studies directly measured metabolic intensity during the sessions themselves, these cardiorespiratory gains likely reflect enhanced ventilatory efficiency, ribcage mobility, and core movement economy rather than pure aerobic conditioning, highlighting Pilates as a potent neuromotor catalyst rather than a direct substitute for high-intensity cardiovascular training.

Simply, the Pilates Method is about optimizing movement efficiency, increasing accessibly mobility and control and adaptability to life’s demands. Is Pilates in and of itself a cardiovascular exercise? No. Does it improve the efficiency of cardiovascular training? Yes.

In Alignment,

Dr. Brent

Research Reviewed: J Clin Med. 2019 Oct 23;8(11):1761. doi: 10.3390/jcm8111761
Pilates Method Improves Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis
Rubén Fernández-Rodríguez 1,2, Celia Álvarez-Bueno 2,3,*, Asunción Ferri-Morales 4, Ana I Torres-Costoso 4, Iván Cavero-Redondo 2, Vicente Martínez-Vizcaíno 2,5
PMCID: PMC6912807 PMID: 31652806

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The Sacred Intelligence of Movement

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By Christine Palumbo, RDH
Polestar Pilates Alumni

The word “spirituality” gets tossed around a lot these days, and it can mean very different things depending on who you ask. For some, spirituality is connected to religion or ritual. For others, it may refer more to presence, self-awareness, connection, or the experience of feeling more integrated within oneself. And when it arrives, I’m certain it does not always come wrapped in some mystical awakening experience. 

Sometimes it emerges much more quietly through breath, attention, embodiment, and presence.

Through both my personal experiences and my education within the Polestar model, I began noticing a close relationship between movement, nervous system regulation, body awareness, and what I have personally come to understand as spirituality when I began taking reformer Pilates classes in 2021.

Like many people, I spent a long time living primarily in my head. As someone who has struggled with anxiety, panic, chronic overthinking, perfectionism, and rumination, I became increasingly aware of how exhausting it feels to live disconnected from the body and trapped in constant mental noise. Pilates became one of the first practices that helped reconnect me to my body in a way that felt grounding, safe, and strangely sacred.

I often think of the mind like the surface of the ocean during rough water. Thoughts, fear, uncertainty, and endless mental loops constantly move at the surface. The mind is incredibly important for reasoning, creativity, and survival, but left unchecked, it can also pull us away from the present moment. Bringing awareness back into the body feels more like moving beneath the surface of the ocean, where things become quieter, steadier, and more regulated.

Modern life often encourages disconnection from the body. We spend our days multitasking, consuming constant stimulation, and functioning within chronic states of stress. Over time, many people lose connection not only to movement itself, but to the intelligent system continuously communicating through breath, tension, sensation, and physical patterning.

Then we enter a Pilates studio.

For one hour, we slow down and pay attention.

We begin noticing unnecessary gripping, breath-holding, or compensation patterns. We notice where the body feels rigid, unstable, or disconnected. Gradually, the body stops becoming something to criticize and instead becomes something to listen to.

One of the most fascinating things to me as both a student and instructor is that the body is constantly communicating information, whether we are consciously listening or not. Movement often reveals things people cannot access cognitively alone. A person may intellectually understand they are stressed or exhausted, yet the nervous system frequently expresses those patterns physically long before the conscious mind fully recognizes them.

In many ways, the body reveals truth.

The body adapts intelligently for survival, protection, and efficiency. Sometimes those adaptations are helpful. Sometimes they become the very patterns that keep people stuck in tension, fear, or disconnection. Pilates gives us an opportunity to observe those adaptations with curiosity rather than judgment.

Interestingly, research within neuroscience and psychology increasingly supports the importance of embodiment and interoception — the ability to sense and interpret the internal state of the body. Studies suggest interoceptive awareness plays an important role in emotional regulation, self-awareness, decision-making, and mental health. Neuroscientist Antonio Damasio, known for his work exploring the relationship between emotion, bodily sensation, and consciousness, wrote that “the body provides more than mere support and modulation for the brain.” In other words, the body is not simply carrying the mind; it actively participates in perception, emotion, and awareness itself.

Research surrounding breath regulation and autonomic nervous system function has also demonstrated that slow, intentional breathing can influence stress physiology, emotional regulation, and feelings of safety within the body. From both instructor and client perspectives, this becomes incredibly relevant inside movement practices like Pilates, where breath, concentration, coordination, and body awareness are continuously integrated together in real time.

As instructors, I think we are often observing far more than movement patterns alone. Sometimes we are witnessing the effects of chronic stress held within the nervous system. Sometimes we are observing protective patterns that developed after injury, pain, or prolonged stress. And sometimes, we are witnessing a person fully experience themselves for the first time.

For many people, the studio becomes one of the few environments where they are fully present within their own experience. There are no external distractions demanding attention. There is only breath, sensation, concentration, movement, and awareness unfolding in real time.

Perhaps spirituality, at least in part, can be understood as the experience of becoming more connected to ourselves through awareness and presence. Through movement, many people begin recognizing that the body is not merely something to control or criticize, but an intelligent system worthy of listening to and understanding.

Ultimately, if we pay close enough attention, we can witness the subtleties of transformation within this work: someone taking a full breath for the first time in years, moving without fear after injury, or softening out of chronic defense patterns.

Perhaps that is part of the deeper power within movement itself: the experience of reconnecting to the sacred intelligence already existing within us.

You can find Christine on social media at:@christine_palumbo_pilates

References:

Craig, A. D. (2002). How do you feel? Interoception: The sense of the physiological condition of the body. Nature Reviews Neuroscience, 3(8), 655–666.

Damasio, A. (1994). Descartes’ Error: Emotion, Reason, and the Human Brain. New York, NY: Putnam.

Mehling, W. E., et al. (2011). Body awareness: A phenomenological inquiry into the common ground of mind-body therapies. Philosophy, Ethics, and Humanities in Medicine, 6(6).

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York, NY: Norton.

Zaccaro, A., et al. (2018). How breath-control can change your life: A systematic review on psychophysiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353.

The Rise of The Movement Practitioner

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This blog is written by Dr. Brent Anderson as part of an ongoing conversation at the intersection of movement science and clinical reasoning.

With the Summer Pathokinesiology Certification cohort opening for registration on May 1, alongside early bird tuition – this is your invitation to step into the work and join a global community advancing how we understand movement and pathology.

The Rise of The Movement Practitioner: Bridging Fitness & Healthcare

The next evolution of healthcare isn’t happening in hospitals, it’s happening in movement studios. A new kind of professional is emerging: one who understands both the science of pathology and the language of movement. Not just instructors. Not just clinicians – Movement practitioners.

Movement practitioners like Shelly Power, who I write about in my blog When Movement Speaks First, are already leading this shift, bridging the gap between what we see in the body and what’s often missed in traditional care. And they are quietly reshaping how we approach health, recovery, and performance.

Every day, people walk into movement spaces carrying far more than a desire to exercise. They bring pain, diagnoses, compensations, fears, and unanswered questions about their bodies. They are navigating chronic conditions, recovering from injuries, or simply trying to feel at home in their bodies again.

Whether we acknowledge it or not, we are making decisions that influence their outcomes.

The challenge is not a lack of care or intention – It’s a lack of framework. Most movement professionals are trained in exercises, but not in how pathology shapes movement, or how movement can influence pathology. So we rely on intuition, experience, and pattern recognition… without always having the language to support it.

But intuition is not guesswork, it’s recognition, and recognition can be trained. When we begin to understand how the body adapts to injury, stress, and disease, movement becomes something more than exercise. It becomes a form of assessment, a form of communication and a form of intervention.

This is where the role begins to shift from instructor to practitioner, and from delivering workouts to making decisions. You stop asking “What exercise should I teach?” and ask “What does this body need?” – This is the work. It requires more than repertoire, and it requires a deeper understanding of how pathology influences movement and how movement, in turn, can influence pathology.

This is the foundation of Pathokinesiology. The study of how pathology impacts movement, and how movement influences pathology. A framework designed to give movement professionals the clarity, confidence, and language to step into this role fully.

Across more than 20 countries, movement professionals are already stepping into this work. They are working with older adults, clients in chronic pain, post-rehabilitation populations, and individuals whose needs don’t fit neatly into a single category.

Not as replacements for healthcare, but as informed collaborators within it – because the future of health is not built on isolated disciplines, it’s built on integration, on communication and on a shared understanding of the human body in motion.

If you’ve ever felt the responsibility of guiding someone through pain,
If you’ve ever questioned whether you’re doing the right thing,
If you’ve ever sensed that there is more to understand beneath what you’re seeing,
I’ve been there, and…You’re right.

And you’re already closer than you think! Pathokinesiology is the next step, and I hope to see you inside!

-Dr.Brent

Learn More Here

Enrollment for the Pathokinesiology Certification Summer Cohort opens May 1, with early bird tuition available—the course begins July 1st.

Pathokinesiology in Action: How Movement Instructors Detect Early Warning Signs

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When Movement Speaks First 

This blog reflects the thinking behind Dr. Brent Anderson’s Pathokinesiology Certification, an advanced exploration of movement, pathology, and critical reasoning. 
Early-bird tuition is available through March 1 → (View program details) 

Shelly Power has been my longtime accomplice in nearly everything Polestar Pilates has become. 

For decades, we’ve taught together, debated together, and built programs side by side. Shelly has an extraordinary ability to see movement clearly, not because she looks harder than others, but because she understands context – she understands people, and she understands history. 

Wellness Practitioners See Early Signs First

One day, she was walking through the studio. A longtime client, someone Shelly had worked with for years, was exercising in the foot straps with another teacher. At first glance, it looked like an ordinary session. But Shelly slowed down. She watched more closely. 

The movement was strange. Not inefficient, not weak or compensatory in any familiar way. It simply didn’t match the body she knew so well. 

Shelly didn’t rush in or label anything – she didn’t diagnose. She recognized that what she was seeing did not belong. She called our lead physical therapist at the time, who specialized in neurology.  They came in and observed quietly for a moment and immediately saw the same thing. Emergency services were called under the concern that the client might be having a stroke. 

She wasn’t, but it turned out she had terminal brain cancer, and Shelly was the first to notice its effects through movement. 

That moment has stayed with me, not because of the outcome, but because of where it began. Not in a hospital or imaging suite, but in a movement studio, during a routine session, observed by someone who knew that body deeply. 

This is something I have seen repeatedly over the years. 

Early indicators of disease often appear first in movement: subtle changes in coordination, timing, orientation, or strategy. And the people most likely to notice those changes are not always clinicians. They are movement professionals who work with clients week after week, year after year. 

Yet many instructors are taught – explicitly or implicitly, to doubt their observations. To stay quiet. To fear overstepping – but clarity is not overstepping. 

Pathokinesiology was created to support that clarity. 

This work does not replace medical evaluation or diagnosis. Those responsibilities rightly belong to licensed professionals. What this training does is strengthen how movement professionals observe, reason, communicate, and collaborate within a broader treatment landscape. 

It allows an instructor to recognize, with confidence and professionalism, when a movement pattern no longer aligns with a client’s known history, and to communicate that observation clearly and appropriately. 

Completing this program represents a deep commitment, nearly a year of study – to understanding how pathology influences movement, and how movement can reflect pathology long before it is formally named. It prepares movement professionals to participate thoughtfully and confidently as part of a treatment plan, without fear and without guesswork. 

The Future of Pilates in Healthcare

Just as important, it builds community! We are intentionally cultivating a network of practitioners equipped to work with diverse populations, people navigating injury, disease processes, deconditioning, stress, and the realities of modern life. 

Today, more than 70% of adults are living with some form of movement dysfunction or disease-related limitation. Sedentary lifestyles, environmental stress, and cumulative load all leave their mark on the body. 

Movement professionals are already on the front lines of this reality. 

Pathokinesiology exists to support them, to give structure to what many already sense, and to elevate movement observation as a meaningful part of prevention, early intervention, and long-term care. 

Sometimes prevention begins with attention. Sometimes early intervention begins with noticing. 
And sometimes, everything changes because someone paused, watched, and trusted what movement was revealing. 

Our first cohort begins in April, and I would genuinely love to have you join us!

-Dr.Brent

For more information on Dr.Brent’s Pathokinesiology Certification – Visit: “Pathokinesiology”

Fascia and Pilates

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Barnes Myofascial Release and Polestar Pilates – a Life Changing Partnership

Guest post by Dr. Carol Davis

In 2013, Brent Anderson and I explored the idea about treating patients with myofascial release at his Polestar Pilates center in Coral Gables across the highway from my office at the University of Miami. I told him I thought that there was a great opportunity for us to collaborate. Manual therapy techniques that offer sustained soft touch and elongation to help release facial restrictions might prove to be a wonderful adjunct for those Pilates patients who can’t seem to smooth out their leg circles or to lie comfortably flat on the reformer bed. And indeed, a wonderful partnership developed over a period of 15 years, where clients and teachers and patients all came together to appreciate and heal in the presence of two powerful therapeutic modalities, Polestar Pilates and JF Barnes Myofascial Release, working in concert for ease and flow and function.

What is myofascial release according to the Barnes sustained soft pressure and elongation approach?

Fascial science has grown exponentially in the last 20 years ever since the emergence of the International Fascia Research Congress in 2007 in Boston, and the premier of Jean-Claude Guimberteau’s groundbreaking video of an endoscopic view of fascia, Strolling Under the Skin,  (https://youtu.be/eW0lvOVKDxE?si=ZuNXZaM7mmZ7mY36)  living fascia that reveals a fascia never before really experienced outside the human body.

Since that time, many have struggled to find words to adequately describe this living vibrating crystalline tissue, found in one continuous web from the top of our heads to the bottom of our feet.  Contiguous, with no beginning and no end.  Many definitions have emerged to try to describe fascia, and each one seems to fall short based on the limitations fostered by the discipline trying to harness this tissue for its own revelations. Anatomists often speak of fascia and layers, but Jean-Claude Guimberteau in his endoscopic view declares there are no layers; fascia exists in us in one continuous web with no spaces and no separations. But try to teach anatomy without identifying layers!  Fascia, all agree, is uniformly made of a mucopolysaccharide Type II gel composed of crystalline water, elastin, collagen, fibroblasts and other cells that are relevant to the area that fascia is supporting.

My own definition of fascia emphasizes the fact that fascia serves as a pathway for the many energetic flows within the body/mind. I maintain that, “Fascia is the living vibrating crystal matrix system within life forms that unites all other systems functionally. This communication flow of information with all systems by way of facial vibration is also known functionally as the mind ; It works to facilitate homeostasis and elevates the importance of fascia to great significance, a hierarchy within heterarchically equal systems of biotensegral energy flowing within and through the architecture of the fascial system.”

Emphasizing the role of energy resonance within and throughout the body connecting every cell, every organ, every system one to another in ongoing communication opens the pathway for consideration of how the energy flowing within us is transmitted through the facial system to our biofield. Fascial vibration offers a hypothetical explanation for how our thoughts and emotions can be transmitted nonverbally to another person. Interesting research is revealing that the intention and attention of the therapist can be energetically, non-verbally received by the interoceptive nervous system of the receiving patient or client.   

Dr. Carol Davis is an author, has been studying with John F. Barnes, PT since 1988, and has been assisting with Myofascial Release Seminars since 1997. To learn more about Fascia from Dr. Davis, please join us this weekend in her 3-hour Online “All Things Fascia” workshop. May 17th, 12-3PM Eastern.

Breast Cancer and Pilates Rehabilitation Choices

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Extract from The Pilates Journal
By Jennifer Guest

To date in 2023, there have been 20,600 new cases of Breast Cancer recorded in Australia (20,395 females and 205 males). The average age of diagnosis is 62 years old, with one in eight being diagnosed before the age of 85 years old.   

The incidence of Breast Cancer is increasing, due to accurate diagnosis with improved screening and hormonal factors which I will elaborate on below. But pleasingly, the mortality rates are reducing as early detection and treatment options are improving.   

Let us look at the hormonal factors. The more estrogen in your body, the higher the risk of developing breast cancer. If you start menstruation prior to 12 years old and do not move through menopause until post 55 years old, you are at higher risk. Those women who have never had a pregnancy also present as a higher risk. 75 per cent of breast cancer is in the ages 50 years plus and those most at risk are women who are post-menopausal.   

There is one genetic factor for Breast Cancer. The BRCA 1 and BRCA2 gene predispose a person to Breast Cancer. If there are changes to these genes, cancer cells will proliferate.   

To read the full article, please visit The Pilates Journal.

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About The Author

Jennifer Guest is an Examiner and Faculty for Polestar Pilates Australia as well as the Director of Smart Health Training and Services in South Australia. You can read more about her here!

Register for this week’s episode of Pilates Hour and join Dr. Brent Anderson and Monica Larcada in a meaningful conversation on breast cancer as Breast Cancer Awareness Month comes to a close.