Pilates, MS and a vision… the role of education and movement in self-management

‘My love of Pilates comes from the fact that I coach and empower individuals to look within’, Rachel said. ‘They can experience movement with a sense of introspection - learning to think, feel and understand their body.

This facilitates an understanding of what is normal, what changes, and how to self-monitor and regulate their condition. Most importantly it cultivates responsive action by individuals to recognise, seek and flag help from their healthcare team appropriately, allowing resources to be used effectively and when needed.’

Since work placements at 16, Rachel set her career path to become a neuro-physiotherapist. Practicing for 14 years and specialising in MS since 2016, she has been keen to help people living with MS to move as well as they can.

'Physiotherapy can be a lot about analysing movement,' explains Rachel. 'In my opinion, we’re not always given the skills to teach it well. Pilates, for me, was the missing link and gave me the tools I needed, using visual, verbal and tactile cues to encourage people how to move themselves well.

It’s about empowering people with MS to explore new and different ways to move.’

Supported self-management

Pilates naturally lends itself to facilitating the art of interoception – the ability for an individual to have self-awareness about the internal workings of their body, including physical, psychological factors and sensing basic needs like thirst and hunger. This, combined with its many physical and cognitive benefits, make it an ideal part of any self-management toolkit.

For some, self-management is an obvious part of accepting their condition and adapting their lifestyle to best support them. However, some people need to be encouraged and equipped with a toolkit to do this.

Rachel is an Associate Trainer for Bridges Self-Management which embodies the idea of encouraging supported self-management. The programme, commissioned by NHS England, coaches clinicians on how to promote the components of self-management such as reflection and self-discovery, helping individuals to navigate living well with a long term condition.

Clinicians may well be signposting people with MS towards Pilates as a positive movement practice both mentally and physically, but Rachel is clear that Pilates instructors themselves may lack confidence in how best to support clients they see with MS.

'I've noticed myself that, even at the early stages of MS, people are slower to process the instructions, and need more time to put themselves into the relevant positions,' Rachel explained.

Whilst most classes will move through around 10 different exercises, with variants on each, a person with MS will more comfortably go through six or seven of those same exercises in the same time period.

Why Pilates?

The evidence for Pilates as a supportive movement practice for those with MS is significant, with evidence to suggest improvements in cognition such as problem-solving and thinking skills, coordination, control, balance, strength and walking ability. Other elements to the practice include breathing control, which promotes respiratory health and balances out the autonomic nervous system, helping to reduce anxiety and stress.

Pilates works the smaller muscle groups that scaffold our skeleton and provide the framework for the larger muscles to function from.

‘Pilates and MS have formed a symbiotic relationship with one another for some time’, Rachel explained. ‘This is because it is a low impact exercise regime that can be adapted to meet all levels of disability. It focuses on balance and control, which are common symptoms experienced by people with MS’.

Whilst it has not been found to be more beneficial than other forms of exercise in large cohort studies, there is a plethora of research demonstrating its value for those with MS nonetheless.

Rachel also points out that it is a form of exercise that can be accessible for those who rely on video instruction - brilliant for those who find the act of getting out to a class challenging, or particularly relevant in our current environment of reduced face-to-face social interaction.

The vision

Rachel is aware that people with MS, hearing about the potential benefits of Pilates, might seek out a local class only to find that the class doesn't quite suit them - they might find it moves too fast, or that their instructor is not sure of how to adapt the movements to their needs.

'I want to support instructors to feel confident in instructing people with MS, to have confidence in approaching changes to the movements, to slow down the practice; but also to be aware of when something might be changing in their client, to be able to talk to them about it, to refer them back to a neuro-physiotherapist for a timely intervention when it's needed.'

Rachel sees this as a form of accredited education with supported guidance and hopes that a long-term result of this could be meaningful data gathering. 'I wonder if we could put subjective outcome measures and quality of life measures in place to gather real data on the impact of Pilates, of self-management, on people's lives with MS.'

This vision places Pilates instructors within the MS service pathway, with dotted referral lines between clinicians, instructors and people with MS. As partners [R2] in their own healthcare journey, those with MS confidently travel that pathway, seeking timely and appropriate intervention from their healthcare team when needed - recognising that need in themselves.

References and further reading:

• Bridges Self-Management
  Providing supportive workshops across people with long-term conditions, health and social care professionals and the voluntary sector to support self-management. They also have some free webinars here.

• Pilates and cognition in MS:
  Küçük F, Kara B, Poyraz EÇ, İdiman E. 'Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial.' J Phys Ther Sci. 2016 Mar;28(3):761-8. Epub 2016 Mar 31.

• Meta-analysis and systematic review of Pilates for MS:
  Sánchez-Lastra MA, Martínez-Aldao D, Molina AJ, Ayán C. 'Pilates for people with multiple sclerosis: A systematic review and meta-analysis'. Mult Scler Relat Disord. 2019 Feb;28:199-212. doi: 10.1016/j.msard.2019.01.006. Epub 2019 Jan 3. Erratum in: Mult Scler Relat Disord. 2019 Jul;32:139-140. PMID: 30623859.

• Mat Pilates and Reformer Pilates and MS:
  Bulguroglu I, Guclu-Gunduz A, Yazici G, Ozkul C, Irkec C, Nazliel B, Batur-Caglayan HZ. The effects of Mat Pilates and Reformer Pilates in patients with Multiple Sclerosis: A randomized controlled study. NeuroRehabilitation. 2017;41(2):413-422. doi: 10.3233/NRE-162121. PMID: 28946576.