When Regina Ronan returned home from work one afternoon in June 2016, she found her husband, Gary Paperno, face down on the bathroom floor. He was conscious but couldn't walk. He had vomited and was bathed in sweat. “We thought it was food poisoning, or maybe dehydration,” she recalls. She rushed him to the hospital and later got the grim news: Her husband had experienced a stroke.

Once it was clear that Paperno would survive, Ronan began asking herself how she could assist in his recovery. She had been certified as a Pilates instructor in 2005 and thought some of those exercises, especially those that targeted the core, could help him. The stroke had damaged his vestibular system—which helps regulate balance—and he could take only a few steps without a walker. “I worried about him navigating the parking lot when he would go to therapy,” says Ronan. “He would be exhausted getting to and from the car.”

Working closely with Paperno's care team, which included a physical therapist, occupational therapist, and vestibular therapist, Ronan created a rehabilitation program for him that combined elements from those disciplines with Pilates, a form of exercise developed by Joseph Pilates after World War I. These low-impact movements focus on flexibility, core strength, and endurance and are designed to improve balance, postural alignment, and stability. Soon after Pilates introduced his series of exercises to Americans in 1923, they became especially popular among dancers such as Martha Graham and George Balanchine, who found them helpful in recovering from injuries and preventing their recurrence.

Nine days after his stroke, Paperno returned to their home in Massapequa Park, NY, and began the program. Because he was unsteady on his feet, he initially did exercises while lying flat on the floor. It was safer for him, Ronan says, and allowed him to work on his coordination and focus. One exercise, designed by the vestibular therapist, involved turning his head slowly and in a controlled fashion from side to side, a move that was “hugely challenging” for Paperno after his stroke, Ronan says. He also did a type of marching—bending the knees with feet on the floor and raising one leg to a 90-degree angle, then lowering it to the floor and repeating on the other side. Eventually he was able to pick up the tempo, simulating a marching motion, which improved his proprioception—his sense of where his body was in space. “These simple movements that we all take for granted like turning our heads from side to side or lifting our legs are really difficult for someone who's had a stroke,” says Ronan.

In the months after his stroke, Paperno dedicated himself to physical and occupational therapy, along with half-hour Pilates sessions under his wife's supervision three times a day. Because he has an athletic background, it was a frequency he could handle—even after his stroke. His improvements were gradual but steady. Once he could raise his arms, he was able to put on a shirt and push himself up out of a chair. Within a few weeks, he started on the Reformer machine, a classic piece of Pilates equipment that uses straps and springs of various tensions to create muscle-strengthening resistance. A cruder form of the machine was developed by Pilates to help injured World War I soldiers increase their strength and fitness while lying in hospital beds. “Every part of my rehabilitation was Pilates-oriented,” Paperno says. “And it really helped.”

“Many people who've had a stroke can benefit from regular exercise,” says Steven C. Cramer, MD, FAAN, a stroke specialist and professor of neurology at UCLA's David Geffen School of Medicine. “It increases cardiovascular fitness and muscle strength, which can improve function.” Other neurologists agree and recommend it for a wide range of neurologic conditions. “There's almost nothing that could bring you into a doctor's office that exercise can't improve,” says A.M. Barrett, MD, FAAN, executive director of the Center for Visual and Neurocognitive Rehabilitation at the Atlanta VA Health Care System.

Any kind of activity will do, says Sudha Seshadri, MD, FAAN, director of the Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases at the University of Texas Health Science Center at San Antonio. “All types of exercise appear to be beneficial, including yoga, tai chi, and Pilates,” she says.

For Mariska Breland, who was diagnosed with multiple sclerosis (MS) in 2002, Pilates has improved her strength, balance, and mobility. Breland, who co-founded the Neuro Studio in Washington, DC, says the movements and machines, which take the body and joints through a full range of motion, have increased her flexibility and stamina. “Reformer exercises that targeted my glutes really helped my balance,” says Breland.

Many studies confirm the value of exercise, and Pilates in particular. For instance, a 2017 study in the Journal of Physical Therapy Science found that Pilates training improved the quality of life for 40 stroke survivors who participated in a 60-minute program twice a week for 12 weeks. The workout comprised a 10-minute warm-up and 40 minutes of mat exercise, supplemented by 10 minutes of movements with balls, bands, and even sandbags that increase resistance and facilitate balance.

In a randomized, controlled trial published in the International Journal of MS Care in 2018, 30 participants with MS either did Pilates twice a week and had a weekly massage or only got a weekly massage. The Pilates group experienced greater improvements in walking and functional ability than the massage-only group.

Mike Knight, a retired communications consultant from Indianapolis who was diagnosed with MS in 2013, says Pilates conferred more than a stronger core and increased flexibility. “I learned about mindfulness and being in the moment,” Knight says. “These are very useful in MS, since our lives can change on a daily or hourly basis.”

The benefits for Paperno have been immeasurable. Despite experiencing a second stroke in 2017, he's now recovered nearly 100 percent. “His posture is erect, and his gait is fluid and natural,” says Ronan. “And he's back to running.”

Paperno continues with his Pilates sessions five days a week. “This is a part of my life now,” he says. “I'm feeling great.”

Pilates Resources

Since the start of the COVID-19 pandemic, most studios, including those listed here, have offered classes online as well as in person.

• Above MS: abovems.com; 800-456-2255
• Balanced Body: pilates.com; 800-745-2837
• The Neuro Studio: theneurostudio.com