Off Your Feet and in the Seat Pilates
On May 31, 2013, Howard K. Koh, M.D., M.P.H., who currently serves as the 14th Assistant Secretary for Health for the U.S. Department of Health and Human Services, spoke at ACSM’s Annual Meeting in Indianapolis. He made a passionate plea for us to explore opportunities to be active in all places where we live, work, shop, pray, and gather. Mary Yoke, M.A., M.M., did just that by offering her 90+year-old seniors a chance to exercise together in a place that was safe, quiet, and convenient. Regular chair Pilates classes were conducted in the quiet comfort of their community’s funeral home. We’ll share with you simple exercises from her program so you too can create activity beyond fitness centers, so people can exercise at work, during TV time, or wherever people gather for “sit down” time.
1. ROUND AND RELEASE
Objective: To promote core awareness and the ability to engage the transverse abdominals by using a hollowing technique so they feel the contrast between spinal flexion and ideal upright seated spinal alignment.
Have participants sit tall, on the edge of a sturdy chair, with feet on the floor about hip-width apart. Cue to feel the weight on their “sit bones” (ischial tuberosities) and tailbone, which is about 0.5 inch above the chair. Weight is on the ischial tuberosities but NOT on the tailbone. We should never sit on our tailbones as a habit, although loads of people do when they slouch (photo 1).
Cue to exhale, sit back — back into the chair…how about curl backward, flexing the lower spine while firmly contracting the abdominals. Imagine pulling the navel to the spine and cue to rock back onto the tailbone into a posterior pelvic tilt (photo 2).
Then, cue to inhale and sit as tall as possible. They should feel their tailbone lift up and off the chair as the weight shifts to their “sit bones,” with the pelvis in a neutral position. The spine also lifts into good upright neutral alignment. Cue to lengthen the neck and lift the chest (photo 3).
Repeat 10 times while emphasizing the hollowing or inward contraction of the abdominal muscles, followed by lifting the spine up into a neutral and slightly extended position.
Modifications, Check/Correct: The main action here is in the lumbar spine; we want to minimize flexion of the thoracic spine (thus not exacerbating kyphosis or forward head). The neck should remain in line with the spine.
2. SEATED TWIST
Objective: To promote muscular endurance of the spine while using good neutral alignment and to train the upper body muscles to stabilize the scapula during movement.
Ask participants to sit on the edge of the chair, with feet on the floor shoulder-width apart. Check that they sit tall on their “sit bones,” with the pelvis and spine in neutral or good alignment with neck straight, crown of the head lifted upward (photo 1).
Next, cue to have them lower or sink their shoulder blades, as if they were putting them into their back pockets. They should maintain a slight retraction of the scapula, using a cue to “squeeze shoulder blades slightly together.”
Have participants reach arms out to the sides, as if they were making a “T” (90 degrees, shoulder abduction) while maintaining scapular retraction (photo 4).
While maintaining alignment, cue participants to twist the upper body to the right and pulse, gently pushing further three times into spinal rotation, exhaling with each pulse. Inhale and return to center, then repeat to the left (photo 5).
Perform three to five repetitions on each side. Have participants notice how, over time, their body tends to fall out of alignment. It will take practice and increased body awareness to perform the exercise correctly.
Modifications, Check/Correct: If you notice participants losing good alignment, check and correct, reduce the number of reps, reduce the range of motion (ROM), or have them bring arms into the body to reduce lever length.
3. BREAST STROKE
Objective: To help correct slouching and counteract the forward pull of gravity that accelerates with aging.
Cue participants to sit on the edge of their chair in good alignment, with feet about hip-width apart on the floor, pelvis in neutral, spine long and tall, crown of the head high (photo 1).
Ask them to lift the arms to bring the hands in front of the chest, reaching forward. Cue to perform a breast stroke, turning the hands from palms down to palms up (photo 6).
Arms should move through the horizontal/transverse plane while performing horizontal shoulder abduction. Simultaneously, cue to lift the chest so the thoracic spine actively extends. Have participants inhale as their head and neck continue to stretch the spine upward. Remind participants to keep the scapulae stabilized, down and back or “packed and grounded” while performing retraction. Cue to exhale as the arms return to the start position in front of the chest (photos 7, 8).
Repeat 8 to 10 times.
Modifications, Check/Correct: Watch for tired arms or shoulder blades raised. Modify by reducing ROM and bring arms closer to the body or by adding a rest. Participants with shoulder problems can work with their arms lower than shoulder height, even, if necessary, keeping their upper arms against the rib cage and performing shoulder external rotation.
4. OBLIQUE ROLL-BACK
Objective: To promote core awareness and strengthen the obliques.
Begin with participants sitting on the edge of the chair with their spine lengthened and the pelvis in neutral (photo 1).
Cue to exhale and roll backward into the chair. Cue to hollow the abdominals, allowing the pelvis to posteriorly tilt while flexing the lumbar spine. Arms can be held in a circle in front (photo 9).
As the participant leans backward, curving the lower spine into a C curve, incorporate a twist to one side. Cue to pause, then inhale and return to neutral, stacking the vertebra one at a time on top of each other (photo 10).
Repeat 8 to 10 times.
Modifications, Check/Correct: It’s important to emphasize that the motion is primarily in the lumbar spine, as excessive upper spinal flexion is not recommended for those with osteoporosis. Althoughthere inevitably will be some flexion in the upper spine, it should be minimized as much as possible. Also, the ROM is relatively small. A good cue is to say “press the lower ribs toward the hip bones while pulling the navel toward the spine.” This exercise is generally fine and quite appropriate even for those with a large mid section. Many obese individuals are not comfortable lying supine on the floor for traditional abdominal work, sothese chair exercises can be an excellent alternative.
5. DEPRESSION DIP
Objective: This exercise helps promote scapular stability by strengthening the lower trapezius and pectoralis minor, muscles that are responsible for scapular depression.
Cue participants to place the heels of their hands on the edge of a sturdy chair. They may be familiar with a basic seated push-up or triceps dip (photo 11).
Guide them to slide forward, allowing their upper body (hips, pelvis, and torso) to hang off the edge of the chair seat. Watch that their elbows are not moving, holding them in a stabilized position (photo 12, 13).
Cue to move the shoulder through the shoulder blades to “shrug” up toward the ears, then exhale as they press the shoulder blades as far down and away from the ears as possible (scapular depression). The only moving body parts should be the scapulae, elevating and depressing as they slide up and down on the posterior rib cage. Be sure to keep the elbows still.
Repeat 8 to 10 times
Modifications, Check/Correct: Watch for tired arms and flexed or trembling elbows or arms. Modify by taking rest breaks or by staying seated as they push down on the chair to engage the scapula in retraction.
Objective: To promote mobility of the spine in lateral flexion and to stretch the latissimus dorsi and oblique muscles.
Participants should begin by sitting on the edge of the chair, feet hip-width apart on the floor, spine erect and in neutral (photo 1).
Cue to place one hand on the side of the chair for support. Then have them inhale and perform a continuous motion, sweeping the opposite arm out to the side and up overhead (photos 14–16).
Encourage participants to exhale as they continue the motion, moving through full range and finally into a side bend (spinal lateral flexion) where they pause, inhale, and return back to the starting position.
Repeat on the other side. Repeat three to five times per side.
While performing the move, cue to keep the shoulder blades in their neutral position — down and slightly retracted. Focus attention on maintaining a long and wide space between the neck and the arm and between the ear and the shoulder.
Modifications, Check/Correct: Be sure to keep the torso lifted and moving in the frontal plane. For those with shoulder issues, simply keep the arm below 90 degrees, moving it in the transverse plane across the front of the body.
7. MERMAID WITH ROTATION
Objective: To gain increased control of spinal motion and improved recruitment of abdominal muscles.
Begin the movement as described in the Mermaid exercise above. As participants move into a supported side bend to one side (frontal plane), cue them to continue exhaling as they curl back to “hollow” or pull in the abdominals. Have them keep moving as they continue to rotate to the side, looking slightly down in a diagonal direction (transverse plane). Cue to inhale as they deliberately move back into spinal lateral flexion (the side bend in the frontal plane), making sure to reposition the body into correct alignment. Finally, have them exhale and return to the starting position (photos 17–20). Repeat three to five times per side.
Modifications: Check/Correct: This exercise does incorporate more upper body spinal flexion than the previous movements. Participants with osteoporosis or any type of back pain should be encouraged to stay with the mermaid exercise described previously, which moves entirely in the frontal plane. Maintain proper scapular placement throughout and watch for a tendency to hunch the shoulders. Place the emphasis on hollowing the abdominals, imagining that they’re lifting up into, and behind, the front of the ribs.
Special thanks to Mary Yoke for her contribution to this column. Mary is a new associate editor of the Journal and currently serves on ACSM’s Health & Fitness Summit Program Committee.© 2013 American College of Sports Medicine.