September 2018 / Study done by Adriano Bittar

Following on the exciting and intriguing postsfrom Christine Bergeron (“How effective is Pilates as an additional training program for dancers?”), and Jennifer Deckert (“Breath: A Back-To-School Basic”), the focus here is also on PILATES and BREATH,specifically touching upon HOW THEY INFLUENCE BALLET.

The basis for any assumption made is a quasi-experimental study, that investigated the effects of Fletcher Pilates® in the respiratory systems of young female ballet dancers from a public dance school. This study was presented as a poster at the IADMS 27th Annual Conference in Houston, USA (BITTAR et al., 2017), and published in Brazil (MELO et al., 2018).


It is well reported by exercise physiologists and physiotherapists (CALAIS-GERMAIN, 2006; HALL, 2016) that BREATH plays an outstanding role in providing the body with the NECESSARY ENERGY FOR DAILY LIVING. Dancers, such as Duncan, Wigman, Humphrey and Graham also used breath to let the body access its FULL VIBRANT POTENCY for ARTISTIC EXPRESSION (SUQUET, 2008). In both cases, the presence of oxygen enables the transformation of fuel molecules into chemical, motion and thermal energies that are applied to better functioning of the human bodies.

Surprisingly, however, breathing is probably THE MOST PRESENT MOVEMENT DYSFUNCTION IN HUMANS (BORDONI & ZANIER, 2013; BORDONI et al., 2018). The shape of the diaphragm, the primary motor muscle in inhalation, affects most body systems, and postural modifications can indirectly challenge ventilation, while coordinated diaphragm contraction may contribute to control of the trunk (HODGES & RICHARDSON, 1997; HODGES & GANDEIVA, 2000, 2000a; GANDEIVA et al., 2002). This is one of the reasons why the placements of the neck, shoulder girdle, ribs and spine could be disrupted by bad breathing. Therefore, applying good breathing principles to our daily living should turn into a practice.

Oddly enough, athletes and dancers, that try to use their bodies to their uttermost capabilities, are often not educated on how to take the best out of their RESPIRATORY SYSTEMS. Even though BALLET DANCERS frequently take Pilates, that teaches breath as a basis for body control, BREATH is normally NOT USED CONSCIOUSLY while they dance(BITTAR et al., 2017). All they learn about breath is: “…don’t let the audience see you are fatigued, keep your breath steady and do not belly breath.”. What could be said of many dancers that finish an adagio, a coda, a contemporary or tap variation in exhaustion, because they keep holding their breaths until they are finished?

Science is starting to understand the benefits of the use of breath. DYSFUNCTIONAL BREATHING has been linked to health problems such as low back pain, anxiety, panic disorder and mood swings, not to mention decreased pain thresholds and impaired motor control, balance, and movement (KIESEL et al., 2017). Yoga and martial arts have used different breathing patterns for ages, such as the parceling of air in and out in fractions, or holding in the air in apnea, that are being practiced to boost better overall health. Western medicine has used breath as well, to improve health and sleep, manage anxiety and control energy levels (MCLAUGHLIN et al., 2011). It is common sense that deep diaphragmatic breathing slows heart rate and blood pressure, especially in times of PERFORMANCE ANXIETY (RAYMOND, 2005). What makes it all even more fascinating is that dancers could use breathing techniques to reprogram their brains, modify the breathing behavior, and break inappropriate breathing habits.

What would be the results of training dancers to understand the relevance of the neuromuscular and biomechanical dimensions of breathing functionality? What would it take to teach them to “move from breath”, so to understand the anatomy, physiology, functions and dysfunctions of breathing? WOULD THEY BE ABLE TO ADD THAT OTHER LAYER OF PERCEPTION TO DANCING? Would it help on their recuperation from their fatiguing routines (parasympathetic inhibition and homeostasis)? Would it also be of help in controlling posture, enhancing performance and for the exploration of a more three-dimensional awareness? These seem to be important questions that need explanation.

FLETCHER PILATES®: breath used consciously

Ron Fletcher (1921 - 2011), an American Pilates elder, ex-Graham dancer and choreographer, developed FLETCHER PILATES®/FP, the FLETCHER FUNDAMENTALSTM/FF and the FLETCHER PERCUSSIVE BREATHTM/FPB after more than 22 years (1948 - 1970) of non-continuous studies with Joseph and Clara Pilates. He was the one that asked Clara’s permission to open a studio in LA. She replied: “Go and do, but always remember your ABCs” (FLETCHER PILATES, 2018).

Ron devoted his life to the understanding of human movement, the use of breath, and the coordination and rhythmic motions of the body.

In the FPB, after a deep costal and thoracic inhalation, air is blown out through the back of the teeth, providing AWARENESS, RESISTANCE AND MORE MUSCLE ENGAGEMENT(BITTAR et al., 2016). Volume and control are key in the FPB, and aspects of breath such as rhythm, regularity, timing and direction are also important. Fletcher believes the breath should be seeing happening in the body, as many body parts move when it is done correctly: “Let the breath inspire the movement. Every body can be improved, inside and outside, because the body potential is hardly ever realized. Body Contrology uses the total person. It is movement that demands thought with spirit with breath with body. One supporting the other.” (FLETCHER PILATES, 2018).

It has been evidenced by early research in diverse populations (VOLÚ et al., 2014; SILVA et al., 2014, 2015; SILVA et al., 2015; BITTAR et al., 2016) that FP and the FPB can increase breathing capacity and lung function, maintain abdominal support of the lumbar spine, improve thoracic spinal mobilization and function and restore optimal posture.

Therefore, would a specific breath, Fletcher Percussive BreathTM/FPB, created by Ron Fletcher, from Fletcher Pilates®, prove to be useful to young ballet dancers, in order to allow for better use of their respiratory systems? It is believed that the FPB will create a better overall use of air by young ballet dancers. 


A quasi-experimental study performed in 2017 evaluated 15 female ballet dancers (age = 12,27 ± 1.10 years; height: 160.67 ± 4.761cm; Body Mass Index/BMI: 16,59 ± 1,43) from a public professional dance school in Goiânia, Goiás, Brazil. All of them had no injuries and were already taking ballet classes and/or rehearsing for at least 5 years, for 15 hours/week or more.

They were submitted to a specific training program with the FP method, that focused on the teaching of the FPB and FF in standing, in 1-hour long classes, for 4 weeks, 2x/week. Classes were taught by a FP Licensed Provider. They all continued their normal dance classes and rehearsals throughout this study.

Subjects were tested pre and post-intervention by their FP teacher for: thoracoabdominal expansibility (cirtometry at the axillary, xiphoid and abdominal/umbilicus levels; in centimeters/cm); maximal expiratory time (Breath-a-Cizer; in seconds/sec); inspiratory muscle strength (Strength Index/SIndex - POWERbreathe®, in centimeters of water/cmH2O); inspiratory flow (Peak Inspiratory Flow/PIF - POWERbreathe®, in liters per seconds/L/sec); mean inhaled air volume (POWERbreathe®, in liters/L).

Statistical analysis was performed using SPSS version 23 software (IBM Inc.). Shapiro-Wilk test followed by Student's or Wilcoxon's paired t tests were applied, according to the normality test results of each domain analyzed. Significance was accepted at the p < 0.05 level.


Xiphoid Expansibility increased (p < 0.01), even though Xiphoid Expiration (p = 0.01) and Inhalation Cirtometry diminished. Abdominal Expansibility Variation was very low, considered abnormal pre-intervention (2.72 cm), and it increased significantly post-intervention (5.53 cm, p = 0.01). SIndex improved to almost double from pre to post-intervention (p < 0.01). PIF improved to almost double from pre to post-intervention (p < 0.01).


FP AND THE FPB HAD A VERY POSITIVE EFFECT OVER THE RESPIRATORY SYSTEMS OF YOUNG FEMALE BALLET DANCERS, influencing positively the mechanics of the breath and the respiratory muscle strength. More studies are needed to verify if these results can be replicated, and if these improvements can be carried over to the betterment of ballet performance. New studies with breath in ballet, in which gold-standard tests are applied, should be carried out.


Results cannot be generalized, as this is the first study performed with FP and the FPBthat looked at the respiratory systems of young ballet dancers. More studies with an experimental design and a greater number of volunteers are needed. Subjective measurements, such as quality of life and ballet performance questionnaires, could also be additionally used, to highlight other physical aspects and their behavior.

1Please refer to Roger Fiammetti’s “Respiration Totale” animation, available at

2For more information on Ron Fletcher and the Fletcher Percussive Breath, please refer to

3Ron Fletcher on Ron’s Clock:


The author has no financial disclosures that would be a potential conflict of interest with this article.


Adriano Bittar - PT, PhD, State Uni of Goiás, Goiânia, Brazil; BR-UK Dance Medicine & Science Network,


BITTAR, A.; MELO, R.; NOLETO, R.; LEMOS, T. The effects of Fletcher Pilates® in the respiratory systems of young female ballet dancers from a public dance school. In: IADMS 27th Annual Conference, 2017, Houston, TX. <iadms-2017-abstract-book.pdf>, p. 78.

BITTAR, A.; JUBÉ, L.; HANCOCK, C.; PAIVA, T.; SABIN, K. The effects of Fletcher Towelwork® in women with breast cancer: clinical trial. PMA Conference, Phoenix, 2016.

BORDONI, B.; ZANIER, E. Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary Healthcare. 2013; 6: 281-291.

BORDONI, B.; PURGOL, S.; BIZZARRI, A.; MODICA, M.; MORABITO, B. The Influence of Breathing on the Central Nervous System. Cureus. 2018; 10(6): e2724.

CALAIS-GERMAIN, B. Anatomy of Breath. Seattle, WY: Eastland Press, 2006.

FLETCHER PILATES, 2018. Retrieved from <>.

HALL, J. Guyton and Hall Textbook of Medical Physiology (13th edition). Philadelphia, PA: Elsevier, 2016.

HODGES, P.; GANDEIVA, S. Activation of the human diaphragm during a repetitive postural task. J Physiol Lond, v.522, p. 165-175, 2000.

HODGES P.; GANDEIVA S. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm.J Appl Physiol, v. 89, p. 967-976, 2000a.

HODGES, P.; RICHARDSON, C. Relationship between limb movement speed and associated contraction of the trunk muscles. Ergonomics, v. 40, p. 220-1230, 1997.

KIESEL, K.; RHODES, T.; MUELLER, J.; WANINGER, A.; BUTLER, R. Development of a Screening Protocol to Identify Individuals with Dysfunctional Breathing. Int J Sports Phys Ther. 2017 Oct; 12(5): p. 774–786.

MCLAUGHLIN, L.; GOLDSMITH, C.; COLEMAN, K. Breathing evaluation and retraining as an adjunct to manual therapy. Man Ther. 2011; 16(1): p. 51-52.

MELO, R.; NOLETO, R.; BITTAR, A.; LEMOS, T. As Influências da Respiração Percussiva Fletcher® nas Mobilidades Torácicas e Abdominal, Força e Coordenação Respiratórias em Bailarinas Jovens de Uma Escola Pública de Dança de Goiânia. MOVIMENTA, V. 11, n. 1, p. 20-34, 2018.

RAYMOND, J.; SAJID, I.; PARKINSON, L.; GRUZELIER, J. Biofeedback and dance performance: a preliminary investigation. Applied Psychophysiology and Biofeedback, v. 30, n. 1, p. 65-73, 2005.

SILVA, G.; RIBEIRO, C.; BITTAR, A. Efeitos do método Fletcher Matwork® na expansibilidade torácica. Artigo de esp. - PUCGO, GYN; 2014.

SILVA, G.; RIBEIRO, C.; BITTAR, A. The Sub-acute Effects of the Fletcher Pilates® Mat on a Group of PE from Athletics Fitness Center. Post-graduation in Pilates, monograph, PUC/GO, 2014.

SILVA, M.; DIAS, K.; BITTAR, A. The Effects of Fletcher Towelwork® in the Peripheral Muscle Strength and Thoracic Extension of Dentists. Summary II International Fletcher Pilates® Conference. Tucson/USA, 2015.

SUQUET, Annie. O Corpo Dançante: um laboratório de percepção. In: COURTINE, Jean-Jacques; CORBIN, Alain; VIGARELLO, Georges. História do Corpo: 3. As mutações do olhar: O século XX. Petrópolis: Vozes, 2008.

VOLÚ, A.; NORA, F.; BITTAR, A. The Importance of Fletcher Towelwork® in Decreasing Shoulder Pain of a Paraplegic bound to a Wheelchair: case study. MOVIMENTA. vol. 7, n. 3, 2014.