Accepted Manuscript

The Pilates breathing technique increases the electromyographic amplitude level of

the deep abdominal muscles in untrained people

Alexandre Wesley Carvalho Barbosa , PT, MSc, PhD Camila Antunes Guedes , PT
Douglas Novaes Bonifácio , PT Angélica de Fátima Silva , Fábio Luiz Mendonça
Martins , PT, MSc, PhD Michelle Cristina Sales Almeida Barbosa , PT, MSc
PII: S1360-8592(14)00083-7
DOI: 10.1016/j.jbmt.2014.05.011
Reference: YJBMT 1139

To appear in: Journal of Bodywork & Movement Therapies

Received Date: 21 November 2013

Revised Date: 12 May 2014
Accepted Date: 23 May 2014

Please cite this article as: Barbosa, A.W.C., Guedes, C.A., Bonifácio, D.N., de Fátima Silva, A., Martins,
F.L.M., Almeida Barbosa, M.C.S., The Pilates breathing technique increases the electromyographic
amplitude level of the deep abdominal muscles in untrained people, Journal of Bodywork & Movement
Therapies (2014), doi: 10.1016/j.jbmt.2014.05.011.

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 ACCEPTED MANUSCRIPT
The Pilates breathing technique increases the

electromyographic amplitude level of the deep abdominal

muscles in untrained people

Alexandre Wesley Carvalho Barbosa, PT, MSc, PhDa,*, Camila Antunes

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Guedes, PTb, Douglas Novaes Bonifácio, PTb, Angélica de Fátima Silvab,

Fábio Luiz Mendonça Martins, PT, MSc, PhDb, Michelle Cristina Sales

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Almeida Barbosa, PT, MScc

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a
Department of Physiotherapy, Department of Graduate in Health Education,

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Federal University of Jequitinhonha and Mucuri Valleys, Minas Gerais, Brazil
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b
Department of Physiotherapy, Federal University of Jequitinhonha and Mucuri

Valleys, Minas Gerais, Brazil

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c
Department of Graduate in Health Education, Federal University of
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Jequitinhonha and Mucuri Valleys, Minas Gerais, Brazil

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Department of Physiotherapy - Federal University of Jequitinhonha and Mucuri

Valleys. Address: Campus JK - Diamantina - MG - MGT 367 Road - Km 583, nº

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5000 - Alto da Jacuba.

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*Correspondent author at: Department of Physiotherapy - Campus JK -

Diamantina - MG - MGT 367 Road - Km 583, nº 5000 - Alto da Jacuba.

Telephone: +55 38 3531 9008. Fax: +55 38 3532 1200. E-mail addresses:

alexwbarbosa@yahoo.com.br, alexandre.barbosa@ufvjm.edu.br
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Abstract

Objective: To evaluate the behaviour of the upper rectus abdominis, lower

rectus abdominis and transverse abdominis/internal oblique (TrA/IO) by using

surface electromyography during trunk flexion with and without the Pilates

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breathing technique. Methods: Nineteen female subjects (without experience

of the Pilates method) were recruited. The muscles were evaluated while

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trunk flexion was performed by using the Pilates breathing technique (POW)

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and Step Barrel device, followed by another contraction without the

technique (NORM). Normality was accepted, and the paired t-test was used to

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determine data differences (p<0.05). Results: Significant differences were
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noted in the amplitude level of activation between TrA/IO-POW and TrA/IO-

NORM. The activation amplitude level of TrA/IO-POW significantly increased

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compared with all the other muscles under the NORM condition. Conclusion:
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The breathing technique of the Pilates method associated with trunk flexion
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increases TrA/IO electrical activity.

Key words: Exercise, Electromyography, Pilates, Breathing

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Introduction
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The Pilates method of exercise (PME) combines exercises into an

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approach towards healthier living (Cruz-Ferreira et al., 2011). The emphasis is

placed on body position control and movement, as suggested by its original

name Contrology (Wells, Kolt and Bialocerkowski, 2012). The PME has changed

from being exclusively used by dancers to become popular in injury

rehabilitation (Latey, 2001).

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Some researchers have questioned the lack of scientific evidence

supporting the use of the PME for fitness and rehabilitation (Aladro-Gonzalvo

et al., 2012; Curnow et al., 2009; Da Fonseca et al., 2009; Sorosky et al.,

2008). However, evidence supports the effectiveness of the PME, mainly by

assisting the trunk muscles reactivate and consequently increasing the support

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of the lower back, but also by reducing pain and disability (Posadzki et al.,

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2011, Wells, Kolt and Bialocerkowski, 2012).

Wells, Kolt and Bialocerkowski (2012) reported on the traditional

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principles of the PME, including concentration (cognitive attention required to

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perform exercise); centring (tightening of the muscular centre of the body or
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‘‘powerhouse’’, located between the pelvic floor and rib cage during

exercises); control (close management of posture and movement during

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exercise); precision (accuracy of exercise technique); flow (smooth transition

of movements within the exercise sequence); and breathing (moving air into
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and out of lungs in coordination with exercise). According to these authors,

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the most frequently reported traditional principle of the PME across all papers
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is breathing. This finding may suggest that these traditional principles, apart

from breathing, are less critical than previously reported (Wells, Kolt and
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Bialocerkowski, 2012). Indeed, the breathing technique seems to help

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coordinate the other principles, providing timing to the exercise and

regulating the level of contraction (Barbosa et al., 2013). However, in order

to understand the role of each principle, it is interesting to assess them

separately, especially the breathing technique.

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The PME is frequently prescribed to people with low back pain because

of its focus on activating the muscles that stabilise the trunk and lower back.

In this sense, the method has similarities with spinal stabilisation training,

both aiming to normalise spinal motor control and both emphasising

transverse abdominis (TrA) and internal oblique (IO) recruitment (Richardson

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et al., 2004; Rydeard et al., 2006). The basis for this approach is that

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repeated activation induces plastic changes in the nervous system, such as

improvements in postural adjustments and the reduced modulation of the

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trained muscle during untrained functional tasks, leading to the modified

automatic recruitment of the trained muscle during the performance of

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untrained functional tasks (Tsao and Hodges, 2008). Both muscles are
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activated during the PME when performed by experienced practitioners
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(Endleman and Critchley, 2008). Herrington and Davies (2005) reported that

participants who had had six months of Pilates training were more able to
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maintain a neutral spine under load, claiming that this represented increased
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TrA activity. However, the immediate effect of the Pilates breathing

technique on TrA or IO electrical activation levels has thus far not been
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evaluated when applied to untrained people.

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A recent review, focusing on healthy people, selected thirty-one

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published reports for potential inclusion in the study, but only sixteen

randomised controlled trials (RCTs) matched the inclusion criteria. The

following criteria were used to grade the strength of the evidence: strong

evidence, provided in multiple high-quality RCTs; moderate evidence,

provided in one high-quality RCT and one or more low-quality RCTs; limited

evidence, provided in one high-quality or multiple low-quality RCTs; and no

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evidence, provided in one low-quality RCT or contradictory outcomes. This

review found strong evidence to support the use of the PME to improve

flexibility and dynamic balance, moderate evidence to improve muscular

endurance and limited evidence to improve TrA, decrease IO thickness during

the performance of the PME, improve reaction time, reduce the number of

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falls and improve life satisfaction, physical self-concept and perception of

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health status. Limited evidence was thus found, with no change in TrA and IO

thickness while at rest or during functional postures (Cruz-Ferreira et al.,

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2011).

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Accordingly, the purpose of this study is to evaluate the behaviour of
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the upper rectus abdominis (URA), lower rectus abdominis (LRA) and TrA/IO

by using surface electromyography (sEMG) during trunk flexion with and

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without the Pilates breathing technique. The developed hypothesis is that

these muscles will be recruited more when the technique is applied.

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Materials and Methods

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Participants

A total of 19 healthy adult subjects (21.22±4.64 years of age;

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IMC=22.74±2.26 kg/m2) participated in this study. The inclusion criterion was

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never experienced the Pilates method. Subjects were selected by

physiotherapeutic assessment to ensure no health problems. The local ethics

committee for human investigation approved the procedures employed in the

study, and all the subjects gave their written informed consent prior to

participation.
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Data recording

A biological signal acquisition module with four analogue channels was

used (MIOTEC Biomedical Equipments, Porto Alegre, RS, Brazil). The

conversion from analogue to digital signals was performed by using an A/D

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board with a 14-bit resolution input range, sampling frequency of 2 kHz,

common rejection module greater than 100 dB, signal/noise ratio less than 03

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µV root mean square (RMS) and impedance of 109 ohms. The sEMG signals

were recorded as the RMS in µV with the surface electrodes (20-mm diameter

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and a centre-to-centre distance of 20 mm). A reference electrode was placed

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on the left lateral humeral epicondyle. Prior to fixing the electrodes, the skin
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was cleaned with 70% alcohol to eliminate residual oil, followed by exfoliation

using a specific sandpaper for skin and a second cleaning with alcohol. The
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muscles analysed by sEMG were as follows and auto-adhesive surface

electrodes (Meditrace Ag/AgCl) were attached onto the muscle bellies and
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positioned parallel to the muscle fibres (right side): (1) TrA/IO: 2 cm inferior
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and 2 cm medial to anterosuperior iliac spine, so that the most superficial

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position of the muscles (TrA and inferior IO) was reliably recorded (Marshall

and Murphy, 2003); (2) URA: 3 cm lateral to midline on the second to topmost
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rectus "bead"; and (3) LRA: 3 cm lateral and 2 cm inferior to the umbilicus
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(Lehman and McGill, 2001) (Figure 1). The sEMG signals were amplified and

filtered (20–450 Hz).

Insert Figure 1

Pilates breathing technique

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The basic Pilates breathing technique consists of (1) deeply exhale

through the mouth – with the lips slightly pursed - during the spinal flexion,

(2) inhale through the nose between the flexion and extension and (3) deeply

exhale through the mouth – with the lips slightly pursed - during the spinal

extension.

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Exercise procedures

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Each volunteer performed three maximum isometric voluntary

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contractions (MVICs) of trunk flexion, followed by 5 minutes of resting. Then,

each volunteer performed three trunk flexion exercises by using a Pilates

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exercise device called a Step Barrel (Figure 2) and the Pilates breathing
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technique, followed by 5 minutes of resting (POW). Other regular three trunk

flexion exercises were performed with a concentric contraction during

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inspiration and an eccentric contraction during expiration (NORM). The sEMG

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data were normalised to MVIC and the mean muscle activity calculated. The
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order of treatment did not vary from one subject to the next between POW

and NORM.
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Insert Figure 2
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Data analysis
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The Shapiro-Wilk test was used to test the Gaussian distribution of the

variables studied. As normality was accepted, the paired t-test was used to

determine whether the differences between the samples were significant at

the p<0.05 level. All the statistical analyses were performed by using

BIOESTAT software (Version 5.0, Belém, PA, Brazil). The G-Power software
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(Franz Faul, Universitat Kiel, Germany) was also used to calculate the effect

size and actual power of the sample.

Results

The sample in this study was built by convenience, and its size was

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chosen to be 19 individuals. Sample size calculations, based on power analysis

(0.9513) and effect size (0.62), showed that the sample was suitable to detect

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changes in the measures under study.

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None of the subjects reported any localised muscle pain during the

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MVICs or the proposed exercises. After the current normalisation by MVIC, the
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paired t-test showed a significant difference in the activation amplitude level

between TrA/IO-POW and TrA/IO-NORM (NORM: 21.80±3.76; POW:

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26.16±3.00; p=0.0166) (Figure 3).

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Insert Figure 3
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Discussion
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It is well documented that abdominal muscles function as an

operational stability system to protect the spine from injury (Hodges et al.,
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2005; Tesh, Dunn and Evans, 1987), suggesting that weakened muscles such as
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the TrA may be responsible for decreased spinal stability (Posadzki, Lizis and

Hagner-Derengowska, 2011). Some exercises can strengthen the superficial

abdominal muscles. However, little is known about effective methods to

strength the TrA muscle. According to Ishida and Watanabe (2013), specific

and isolated exercises for strengthening the TrA might be required, especially

because contracting the TrA increases intra-abdominal pressure and the

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tension of the thoracolumbar fascia, creating a stabilising corset effect

(Kliber, Press and Sciascia, 2006).

The current study noted an increased activation level between TrA/IO-

NORM and TrA/IO-POW, suggesting that breathing plays an important role in

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muscle activation level. A recent study observed a selective increase in TrA

muscle thickness after maximum expiration, suggesting that the TrA muscle

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may exhibit stronger contraction during maximum expiration (Ishida and

Watanabe, 2013).

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Additionally, another recent study, which recorded the sEMG data from

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back muscles while subjects performed a trunk flexion motion for four
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different attention conditions, suggested that the neuromuscular response is

sensitive to directed cognitive demands (Butler et al., 2010). As the current

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subjects had not experienced the Pilates breathing technique before, they
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had to pay more attention to the task, controlling some variables such as
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respiration, movement velocity and range of motion, which could have led to

this pattern of muscle activation.

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Although the current results did not show any differences between the
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URA and LRA, a study has shown that the sEMG data of the upper and lower
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portions during a curl up exercise are significantly larger than during a leg

raise exercise at low-intensity contractions. The difference between the RMS

values of the sEMG data suggests that the different portions are selectively

recruited during these two tasks. In other words, the ratio between the sEMG

data of the upper and lower portions during the curl up exercise was

significantly larger than that during the leg raise exercise (Duarte, Kohn and
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Marchetti, 2011). Based on these results, the hypothesis is that the device

used (i.e. the Step Barrel) provided support and an angle limitation to the

trunk movement, not eliciting, during the task, an adequate recruitment of

the URA/LRA as agonists of trunk flexion. Additionally, some limitations may

be addressed in the current study. Although the number of subjects was

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enough to show the significant effect of TrA/IO activation, it might have been

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too small to show more changes in the pattern of activation amplitude level in

the abdominal wall muscles. Muscle force was also not assessed; therefore,

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we do not know how much force was developed during the exercises. This

information could help better establish the exercise and the breathing

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technique as the correct way to achieve TrA/IO strength and segmental
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stabilisation. However, the intensity used in the proposed exercise was small.
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The breathing technique of the Pilates method associated with trunk

flexion with the Step Barrel device increases TrA/IO activity compared with
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the URA and LRA. Therefore, it could be implemented to start the PME
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program, especially to facilitate the subject’s comprehension about how the

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deep abdominal muscles contract during trunk movements, one of the most

difficult aims to achieve at the beginning of an exercise program.

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Acknowledgements
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We gratefully thank the Foundation for Research Support of Minas Gerais –

FAPEMIG for its financial support.

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Figure 1 Electrodes placement: upper rectus abdominis (a); lower rectus

abdominis (b) and the acronym transverse abdominal/internal oblique (c).

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Figure 2 Step barrel.

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35

30

26.16 *
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23.78
21.21 21.58 21.80 *
% MVIC

20 19.47

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15

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10

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5 NORM
POW
0

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URA LRA TrA/IO
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Figure 3 Percentage of maximal voluntary isometric contraction: upper rectus

abdominis - URA, lower rectus addominis – LRA and transverse

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abdominis/internal oblique – TrA/IO during trunk flexion with (POW) and

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without (NORM) Pilates breathing technique (*p=0.0166).

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