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Gym woman pilates stretching sport in reformer bed

The Role of the Pilates Professional in Cancer Treatment and Rehabilitation

I am a 12 year breast cancer survivor, and experienced what cancer patients go through, not just from theory, but from living it. I’m going to talk about the role that Pilates had in my rehab and why I consider essential for cancer patients and survivors.

After surgery and treatment, most cancer patients are left with lack of flexibility and range of motion, and poor posture because of the scar tissue. Most experience fatigue from chemo and radiation or just stress of the circumstances. Many go through hormonal treatment which reduces the muscle mass, increases the risk of osteoporosis and bone fracture, bone pain, fatigue, mood swings and lack of stamina and stress.

Breathing is an essential part of Pilates. It helps with stress and stamina, reduces fatigue, opens the lungs and helps with mood swings. When we are paying attention to our breathing, we clear thoughts and allow the oxygen and energy flow through our bodies.

Awareness is a principle that helps us increase the consciousness of our body and the parts that are in disharmony and need to be repaired, isolating them from other parts to progressively make them stronger and healthier. Mind –Body connection

Control is another principle helps coordinate the body parts and move them with the correct alignment, avoiding jerky movements used in general workouts (especially using the Core which we call the powerhouse) and increasing BALANCE that is so affected in cancer patients.

Flexibility and range of motion are key in the rehabilitation for mobility and functionality of the limbs or part of the body affected so we start testing the patient range of motion without any resistance at first.

Pilates machines have springs that allow switching among different resistance according to the patient’s condition avoiding injuries and pain,

Allowing the patient to get FLEXIBLE then STRONGER and then MANAGE THEIR OWN BODY improving posture, Functionality, mobility, self-image and self-confidence.

Exercise Samples

Graciela Perez is a National Academy of Sports Medicine (NASM) Personal Trainer, Aerobics and Fitness Association of America (AFAA) Aquatic Specialist, and a Cancer Exercise Training Institute Cancer Exercise Specialist. She’s been helping people reaching their health and fitness goals since 2003. 


What is the Difference Between Pilates and Yoga breathing?

As an Occupational Therapist, many patients come to me who are in pain and are suffering from a variety of issues including breast cancer, repetitive stress injuries, musculoskeletal problems, and back pain. I use both Yoga and Pilates in my practice Integrated Mind and Body in Boston for relaxation, and to help prepare patients physically and psychologically for the treatments that I offer.

Aerobics Pilates personal trainer helping women group

Pilates for Breast Cancer Survivors

Pilates training can be an excellent way to achieve the postural re-education and muscle-balancing necessary to recover from the side effects of breast cancer treatment. Pilates can help alleviate pain from breast cancer operative procedures, restore joint mobility and tissue integrity, and help regain lost strength. Most importantly, Pilates can be a gateway for a true “Return to Life” for many women, as the title of Joseph Pilates’ popular book states. However, Pilates instructors should be on the lookout for some often coincident injuries that will require additional special knowledge about the shoulder complex in order to work safely and effectively with the growing population of breast cancer survivors.

pilates woman stability ball gym fitness yoga

Pilates Exercises for Healing: Shoulder Stretches and Bridging

There are three phases of Pilates for breast cancer survivors. The goal of Phase 1, the Protective Phase, is to ensure tissue healing without sacrificing range of motion and flexibility of the chest and arm. In these exercises, only move your arms to shoulder height or 90° and during this phase try to use your affected arm normally to perform daily living tasks such as brushing your teeth, putting on deodorant on, or wiping up your kitchen table.

Below are two examples of Pilates exercises for breast cancer survivors that fall under the Protective Phase. Protective Phase exercises should have three to five repetitions each. This phase will last approximately 2 weeks, or until you feel comfortable progressing to more difficult exercises. The exercises should feel easier and there should be less and less discomfort as you progress.

Exercise 1: Scapula Protraction and Retraction

The scapula is another name for your shoulder blade. The purpose of this exercise (shown in the image below) is to warm up the shoulders in preparation for movement, as well as strengthen the scapular muscles, which are necessary for proper shoulder movement.

Contraindications: None

Equipment: Pad, small pillow, towel, or block under head if needed. Optional medium-sized ball (squeezing the ball between your knees will help to activate the pelvic floor and transverse abdominis muscles and prevent your knees from collapsing in).


  • Lie on your back with both knees bent and feet on the ground, hip distance apart.
  • Pelvis is level with the floor or slightly tilted toward your nose if you have back problems.
  • Arms and fingertips are reaching toward the ceiling only to shoulder height.
  • Optional: Squeeze ball between your knees.


  • Inhale, and reach fingers tips toward the ceiling (shoulder blades will lift off the mat). This is protraction.
  • Exhale, and bring your shoulder blades together (not too hard) as you imagine you are gently cracking a walnut between your shoulder blades. This is retraction.

Modification for an Added Challenge: Stretch a resistance band between your hands. If you are undergoing a breast implant expander program, TRAM, or DIEP flap reconstruction, do not use a resistance band until medically cleared.

Exercise 2: Bridging

The goal of bridging is to warm up the spine as well as your hamstrings and gluteal muscles. This exercise will help make it easier to put on your underwear and pants and reposition yourself in bed.

Contraindications: Check with your physician to make sure that this exercise is safe for you to do when recovering with drains in place.

Equipment: Pad, small pillow, towel, or block under head if needed. Optional medium-sized ball (squeezing the ball between your knees will help to activate the pelvic floor and transverse abdominis muscles and prevent your knees from collapsing in).


  • Lie on your back with both knees bent and feet on the ground, hip distance apart.
  • Pelvis is level with the floor or slightly tilted toward your nose if you have back problems.
  • Arms are long at your sides.
  • Optional: Squeeze ball between your knees.


  • Inhale to start, and then exhale as you tilt your pelvis toward your nose to imprint your spine.
  • Then push off through your heels, and lift your spine off the mat one vertebrae at a time. You will start moving the lower back, middle back, and then upper back off the mat.
  • Inhale as you hold this position at the point where you can remain still, without any movement of your pelvis. Both the upper part of your shoulder blades should remain on the mat.
  • Exhale as you return to the start position by gradually bringing the upper back, middle back, and lower back gently down to the mat, vertebrae by vertebrae to your neutral or imprinted pelvis. Think of rolling the spine slowly down to the floor.

NOTE: Be sure to… Keep both shoulder blades on the mat. Do not let the pelvis rock forward/back or side to side.

Modification for an Added Challenge: Hold a Magic Circle between your inner thighs for resistance as you lift your hips. Hold a Magic Circle between your palms with hands facing each other and fingertips toward the ceiling. Squeeze it when the hips are lifted.

Written by Naomi Aaronson and Ann Marie Turo. Reprinted with permission from Naomi Aaronson, MA, OTR/L, CHT; Also published on demosHEALTH; Images via demosHealth article.

Naomi Aaronson, MA, OTR/L, CHT can be reached at www.recovercisesforwellness.com.

Aerobic Pilates personal trainer instructor women

Pilates for Breast Cancer Survivors: Research and Findings

Pilates was first developed by Joseph Pilates to strengthen muscles, increase flexibility, and improve overall health. In the 1950s, Pilates started using his method to rehabilitate dancers, including one of his first protégés, Eve Gentry. She was rehabilitated by Joseph Pilates after a radical mastectomy for breast cancer. After studying Pilates, she was able to regain full use of her arm and torso, a remarkable feat because all of her lymph nodes and chest muscles, as well as breast tissue, were removed with this procedure. Doctors could not believe the success that she had obtained with the Joseph Pilates method; he was a man ahead of the times.

Recent research and studies have helped supported Pilates’ work and demonstrate its benefits for recovering from breast cancer surgery.

Recent Research and Findings

Aerobics Pilates personal trainer helping women groupThe first study on the benefits of Pilates for breast cancer survivors was completed by physical therapists in 2008 [1]. It was a pilot study with only four participants, so the conclusions we can draw from this study are limited. However, they found that Pilates increased the flexibility of the affected arm after a twelve-week program, with participants exercising three times a week.

Another study done in 2010 [2] examined the effects of Pilates exercises on functional capacity, flexibility, fatigue, depression, and quality of life in female breast cancer patients. Pilates was performed three times a week for eight weeks. After participation in the Pilates exercises, improvements were noted in the participants’ levels of fatigue, flexibility, quality of life, and performance on a six minute walk test. This study helped demonstrate that Pilates was safe and effective for breast cancer survivors.

The most recent study published in 2012 [3] found that after twelve weeks of Pilates, thirteen participants improved their shoulder and neck flexibility. Improvements were noted in quality of life, body image, and mood. Although volume increased on the affected arm (a sign of lymphedema), one must note that this program did not modify the exercises for the class and that the sessions increased in frequency over the twelve-week period.

It is important to note that traditional Pilates mat exercises were used for the studies listed above, and minimal modifications were used which may have affected the results. However, all of these documented results help confirm that Pilates is a gentle but effective way to regain strength and recover from breast cancer.

Keays, K, Harris, S, et al. “Effects of Pilates Exercises on Shoulder Range of Motion, Pain, Mood and Upper Extremity Function in Women Living with Breast Cancer: A Pilot Study.” Physical Therapy 88(4) (2008): 494–510.

Eyigor, S, Karapolat, H, et al. “Effects of Pilates Exercises on Functional Capacity, Flexibility, Fatigue, Depression and Quality of Life in Female Breast Cancer Patients: A Randomized Study.” European Journal of Physical Medicine 46(4) (2010): 481–87.

Stan, DL, Rausch, SM, et al. “Pilates for Breast Cancer Survivors: Impact on Physical Parameters and Quality of Life After Mastectomy.” Clinical Journal of Oncology Nursing 16(2) (2012): 131–41.

Written by Naomi Aaronson and Ann Marie Turo. Reprinted with permission from Naomi Aaronson, MA, OTR/L, CHT; Also published on demosHEALTH.

Naomi Aaronson, MA, OTR/L, CHT can be reached at www.recovercisesforwellness.com.

Aerobics pilates women feet  with yoga balls

The 9 Principles of Pilates

For breast cancer survivors using Pilates, it is extremely important to pay attention to the Pilates principles. Getting physical exercise is essential to recovery, but overdoing it can cause more harm than good. Make sure you review the principles below before beginning Pilates for breast cancer recovery, and ask for help from a certified Pilates instructor if you need it.

The 9 Pilates Principles

These principles guide each Pilates exercise to ensure that they are done correctly and safely. In Pilates, less is more. The emphasis is on a correct starting position with proper execution of the exercises; there is no wasted movement in Pilates. No more than five to eight repetitions are completed (except for the Hundreds), and breathing during each exercise is very important. Concentrate on the correct movement patterns first and then add Pilates breathing.

pilates woman stability ball gym fitness yogaIf you’ve never done Pilates before, this may sound like a lot to think about. If possible, we recommend working with someone who is trained in Pilates first to get you on the right track.

  1. Breathing: Breathing oxygenates the blood and connects the mind and body. Breathing during Pilates will enhance your relaxation, improve your focus, and help to activate your muscles. Pilates breathing is called “rib cage breathing” or costal breathing as the rib cage expands as you inhale and knits together as you exhale. Coordinating the breath with the movement is the goal. This may be difficult at first, but please stay with it. If you get confused, don’t hold your breath—keep breathing!
    • Inhale through the nose as if to smell the roses. Place your fingers on your rib cage and feel your rib cage expand.
    • Exhale through pursed lips as to blow out candles, drawing the belly in towards your spine. This activates the transverse abdominas muscle. The deeper the exhalation, the more this muscle is activated. Activation of this muscle should feel very gentle, as it is more like a subtle tightening of the abdomen. The lower back and pelvis should remain still. Buttocks and thighs should stay relaxed.
  2. Concentration: You must place intentional focus on every movement. You will feel each exercise more if you close your eyes, once you become more familiar with the movements. After breast cancer surgery, you may lose the ability to feel if muscles are working properly. Closing your eyes will help in this process to listen to your body and refocus your mind upon proper body movement.
  3. Control: To be in control means that you maintain the proper form, alignment, and effort during the exercise. You don’t want to throw your body around. If there is jerkiness, shaking, tightness and/or pain you are not in control. You can limit the movement and make it smaller if necessary to regain control.
  4. Centering: In Pilates, all movements come from the “powerhouse,” or core abdominal muscles. Learning to use the powerhouse correctly will improve your posture, stabilize the spine, and improve your quality of movement. Thus, every exercise is an abdominal exercise. Visualizing a corset around the waist will help you to activate these muscles.
  5. Precision: Every exercise should be performed with precision and an emphasis upon proper form. Therefore, proper starting position and posture is crucial as well as performing the exercises slowly without momentum.
  6. Pilates aerobic personal trainer man in cadillacBalanced Muscle Development: Everything that is done on one side of the body must also be done on the other side. For example, if you do an exercise with your right arm, you must also do it with your left.
  7. Rhythm/Flow: All movements in Pilates are done with a sense of rhythm. The movements should be graceful and smooth.
  8. Whole Body Movement: The whole body is engaged through breathing, engagement of the core, and use of the arms and legs (even though some exercises will not use the arms at all).
  9. Relaxation: Breathing assists with the relaxation of muscles throughout the body. Unwanted tension should be released prior to beginning the exercises. You may work one body part and relax the others

Written by Naomi Aaronson and Ann Marie Turo. Reprinted with permission from Naomi Aaronson, MA, OTR/L, CHT; Also published on demosHEALTH.

Naomi Aaronson, MA, OTR/L, CHT can be reached at www.recovercisesforwellness.com.