The purpose of this issue is to highlight the role of mindful movement, Pilates, and Pilates-related movement modalities in improving the health and quality of life for older adults. One of the unique elements of Pilates and related mindful movement modalities is the emphasis on client empowerment and increased proprioception. Practitioners use specific verbal and manual cueing designed to enhance the client's understanding and awareness of movement patterns. Through education and self-awareness, clients are given the tools to notice and improve dysfunctional, or less than optimum, movement patterns.

Pilates and related modalities are already used by many older patients for health maintenance, sports-specific skill improvement, and rehabilitation because of the perceived safety and efficacy of the flexible, low-impact Pilates-based environment. Another benefit of Pilates, and related modalities, is their relative gentleness, accessibility, and effectiveness for clients with injuries or physical limitations. The nurturing environment of many Pilates studios and clinics can improve exercise program compliance for patients who are afraid of exercise or have limitations that preclude them from working out in a more traditional gym environment.

This issue of Topics in Geriatric Rehabilitation explores how Pilates and mindful movement fit into the overall health maintenance and rehabilitation framework for the older adult.

This issue specifically addresses:

* The importance of exercise for older adults and the role Pilates and related mindful movement modalities may play in decreasing the deleterious effects of inactivity that are at the root of many chronic age-related health conditions.

* Pilates as a supplemental recovery option for patients with breast cancer. Clients with breast cancer, depending on the type of surgical intervention and reconstruction, are often left with significant movement impairments. Pilates can provide a useful environment in which to recover useful function of the affected areas and can bridge the gap of care that often occurs following surgery and other interventions.

* How Pilates can help mitigate the effects of adult degenerative scoliosis. Adult degenerative scoliosis is distinct from childhood scoliosis, and Pilates may provide a valuable, effective, and customizable intervention.

* The effectiveness of Pilates in athletic training of the performance skills of a master-level senior athlete. It can become more difficult to improve one's athletic skills with age. However, in a case study of a 71-year-old equestrian master athlete, Pilates was used to improve the hip and spine positions, increase strength and flexibility, and improve the motor control and neuromuscular pathways required for success. This case study shows the value of continuing to work to improve one's performance as a way to stay actively engaged in improving one's quality of life.

* Pilates-based interventions are useful for improved daily functioning and long-term outcomes for a patient with osteoporosis. An additional case study highlights the promise of Pilates in fall prevention and for enhancing balance and coordination as we age.

* Fitness protocols for the pelvic floor and how pelvic floor exercise training may be a viable, nonsurgical option to help deal with bladder control, prolapse, and pelvic floor dysfunction.

* How fascia relates to movement in the aging body.

* How a Pilates-related apparatus, the CoreAlign, can effectively be used to analyze and retrain gait. The CoreAlign provides an environment where reciprocal leg motion can be either isolated or integrated with the torso, arms, and head to retrain gait.

The role of mindful movement, Pilates, and related modalities in rehabilitation of the geriatric population has promise for patients with a variety of conditions. Exercise and movement, in and of itself, may be one of the most effective, and cost-effective, means for improving quality of life and decreasing or minimizing chronic conditions.

Pilates as a method develops strength, flexibility, and improved motor control. Mindfulness empowers patients through education, improved proprioception, and self-awareness. Together, Pilates, mindfulness, and movement create powerful tools for physical therapists and practitioners alike to create opportunities for the older adult to age successfully, enhance quality of life, and restore ability and function.

-Nora St. John, MS

Director

Education, Balanced Body, Inc

Sacramento, California