Better Breathing: Using Pilates and Foundation Training to alleviate the respiratory effects of neurodegenerative disorders

Neuromuscular disorders can be a damaging bunch indeed. The category includes multiple sclerosis, Parkinson’s disease, Duchenne muscular dystrophy, Huntington disease and other neurodegenerative disorders of the central nervous system. While the etiology of each disease may be different, all share the common symptom of respiratory dysfunction. Their symptoms often start quietly and insidiously, making it difficult to recognize whether a NMD has taken hold until extreme respiratory duress becomes apparent.¹ ²

Although later-stage symptoms of the disorders may seem to erupt suddenly, they have actually been long-developing in a chain of respiratory insufficiencies that result from the conditions. That chain, however, can be broken. Symptoms may be alleviated, halted or even prevented with a regular practice of Pilates and foundation training.

Respiratory Effects

Neurodegenerative disorders cause respiratory insufficiency due to a debilitating collection of interrelated symptoms that lead to deterioration of respiratory function.¹ The disorders can weaken the abdominal muscles, which decreases the effectiveness of the cough to clear congestion from the respiratory tract. Bronchial congestion and pulmonary infections then set in, resulting in obstruction of the upper airway and reducing oxygen intake. Muscles have to work harder to breathe and become fatigued, while low oxygen levels in the blood cause even more problems.¹

Weight loss, problems sleeping, poor concentration, and recurrent chest infections often become the norm. Breathing can be further impaired by weakened chest muscles and a weakened diaphragm, along with abnormal spinal curvature, all of which impede the lungs.¹ The risk of pneumonia increases while the ability to exercise or perform activities of daily living decrease.² Lack of exercise and sustained movement adds to overall muscle weakness, continuing the cycle of deterioration.

Eliminating, or even preventing, the deterioration has been shown to be possible through exercise, specifically respiratory muscle training.¹⁻⁴ Such training is designed to increase the strength and endurance of the muscles used for breathing, which, in turn, may delay breathing impairments, increase the effectiveness of the cough and increase the overall lung capacity.²⁻⁴ The increased oxygen levels serve to stave off fatigue and allow people to perform more activities for longer periods throughout their day.⁵

Pilates and Foundation Training

Pilates and foundation training (FT) are two exercise modalities that can work together to improve respiratory functioning. They both focus on the same physical aspects, just in a slightly different manner. Those suffering from neuromuscular disorders can especially benefit from the disciplines, although all those who engage in a regular practice can reap the rewards.

Pilates, developed by Joseph Pilates in the early 1920s, is a program that aims to improve strength, flexibility and posture, while coordinating the body and mind. It incorporates proper breathing techniques, muscle chains, muscle control, and an intense focus on the core muscles, and may implement special equipment to intensify results.⁶ The practice involves 500 different exercises, all of which contribute to the strengthening and stabilization of the core.

Individualized Instruction

Foundation training, developed by Eric Goodman, is a much more recent addition to the fitness arena that aims to help people develop proper movements, or those performed in the way the body was designed to move. Like Pilates, FT focuses on posture, proper breathing techniques, muscle control, core development, and muscle chains, with a particularly heavy emphasis on the posterior chain that includes the back, neck, gluteal muscles, hamstrings, calves and heels.⁷

The two modalities work very similar parts of the body with a slightly different emphasis, which is what makes each discipline unique. It’s also what creates different types of results for the same focus areas, namely the breath, posture, core and muscle groups. Using either discipline on its own produces myriad benefits, which are further enhanced when the two programs are combined into a comprehensive treatment plan.

Applications for Respiratory Care

Both Pilates and foundation training focus on breathing, and both aim to create as much space as possible between the pelvis and ribcage to allow for the fullest, deepest breaths. One of the ways they do this is by paying acute attention to the core muscles and posterior muscle chain. While the definition of core differs slightly between Pilates and FT, both involve the muscles in and around the pelvic area.

The strengthening and stability of muscles in the trunk and posterior chain help to create the desired space between the ribcage and pelvis through anchoring and decompression. The pelvis is anchored to the leg muscles, keeping the body foundation stable while giving the lungs and diaphragm plenty of room in which to function.⁸

Decompression is taking place, with a subtle lengthening of spinal muscles due to counteractions of downward and upward spinal traction. The downward traction is created by the pelvic anchoring, while the upward spiral comes from muscular deep breathing. The slight elongation of the spine again provides ample breathing room by helping to maintain the body in its proper postural positioning, in which all organs are properly aligned and positioned.

Respiratory functioning is also enhanced by engaging in deep breathing techniques in Pilates and structural breathing in FT.⁸ ⁹ Pilates encourages complete inhalations and exhalations, stressing the importance of “squeezing” every single atom of air out of the lungs with the deepest of exhalations.

The structural breathing of FT is of the type that encourages the greatest amount of space between the pelvic floor and ribcage, keeping the chin pulled back while inhaling and exhaling as deeply and fully as possible. Each inhale should produce the needed space below your ribcage. Each exhale should involve the tightening of your abdomen to prevent your core from collapsing.⁹ Such deep breathing supplies the body with copious amounts of oxygen, stimulates muscle activity, maintains respiratory muscle strength, and can decrease the onset of symptoms caused by an oxygen-poor environment.

Ongoing Health Improvement

Unlike other exercise methods that may focus on a specific area that needs improvement, Pilates and foundation training focus on the core to produce an improvement in the body as a whole. The proper posture and body alignment that result from Pilates and FT set the stage for all other muscles and organs to function at their optimum capacity.

The lungs and diaphragm are given adequate room to breathe, respiratory muscles are strengthened, coughs once again become effective, and oxygen flow is improved. When implemented during the early stages of neuromuscular disorders, Pilates and FT may effectively deter or prevent the various debilitating symptoms that start with abnormal blood gases due to insufficient oxygen levels.¹

Pilates and FT are also much more than a one-time exercise solution, but rather the foundation for optimal physical health for an entire lifespan. With proper initial instruction and sufficient repetition, the movements become instilled in the cognitive and muscle memories, allowing the body to retain and recall the movements automatically as it moves throughout daily life.

Because the body is performing in the manner in which it was designed, efficiency and endurance levels automatically increase, leading to improvement in exercise capacity and capabilities to perform activities of daily life. The strong structural foundation additionally serves as a baseline for any other exercise program or activities, effectively integrating other muscle groups as needed.

Treatment Plan

While Pilates and foundation training may not have the power to cure neuromuscular disorders, the two in tandem can serve as an integral component in a treatment plan to decrease, alleviate and possibly even prevent symptoms. The two may be used on their own or as part of a larger treatment program that includes other physical and medical components.

One of the keys to neuromuscular disorder treatment is starting a program as early as possible, which reinforces the importance of ongoing pulmonary testing and monitoring. Instead of falling prey to the debilitating chain of symptoms that stem from neuromuscular disorders, those who embrace Pilates and FT can instead establish a positive chain of reactions that contribute to overall health and well-being for years to come.

Michael Salvatore is a certified Pilates instructor and creator of Foundation Pilates. He holds certifications in Romana’s Pilates, Foundation Training and clinical orthopedic manual therapy, along with an MBA from Suffolk University and a bachelor’s degree in neuropsychology from Boston University. He designs customized Pilates programs for athletes, performing artists and other professionals and lives by the tenet that a great body starts with a great foundation.

Salvatore, M. Better Breathing: Using Pilates and foundation training to alleviate the respiratory effects of neurodegenerative disorders. Advance for Physical Therapy. 2014; 25(2): 19-20.


  1. B. Estournet B. Respiratory care in neuromuscular disorders. In: Dulac O, Lassonde M, and Sarnat HB, ed. Handbook of Clinical Neurology. 3rd series. Elsevier BV; 2013: 1485-1490.
  2. Reyes A, Ziman M, Nosaka K. Respiratory Muscle Training for Respiratory Deficits in Neurodegenerative Disorders. Chest. 2013; 143(5):1386-1394.
  3. Chest wall mobility is related to respiratory muscle strength and lung volumes in healthy subjects. Respiratory Care. 2013;1-22.
  4. Jones U, Enright S, Busse M. Management of respiratory problems in people with neurodegenerative conditions: a narrative review. Physiotherapy. 2012;98:1-12.
  5. Ray A, Udhoji S, Mashtare T, Fisher N. A Combined Inspiratory and Expiratory Muscle Training Program Improves Respiratory Muscle Strength and Fatigue in Multiple Sclerosis. Archives of Physical Medicine and Rehabilitation. 2013;94:1964-70.
  6. Wells C, Kolt G, Bialocerkowski A. Defining Pilates exercise: A systematic review.Complementary Therapies in Medicine. 2012; 20:253-262.
  7. Goodman E, Park P. Foundation: Redefine Your Core, Conquer Back Pain, and Move with Confidence. Rodale Books; 2011.
  8. Pilates J, Miller J. Return to Life Through Contrology. 2nd ed. Presentation Dynamics Inc.; 1998.
  9. Foundation Training. Accessed Nov. 6, 2013.