Pilates: what it is, how to start, and what it really does

A mind–body method

A systematic review of 119 papers concluded that Pilates is a mind–body exercise focused on strength, core stability, flexibility, muscle control, posture and breathing. It can be done on a mat with no equipment, or on spring-loaded apparatus: the reformer, the Cadillac (trapeze table), the Wunda chair and the ladder barrel.

Source 1

Joseph Pilates, briefly

Joseph Hubertus Pilates was born on 9 December 1883 in Mönchengladbach, Germany. He was in England when the First World War began, was interned as an enemy alien on the Isle of Man, and led daily exercise for his fellow internees. He later taught in New York (sources differ on the year he settled there). He died in October 1967, and his wife Clara ran the New York studio until 1970.

Research reviews date the method to the 1920s.

Sources 2, 1

The 34 mat exercises

After an earlier book, Your Health (1934), he set out 34 mat exercises in Return to Life Through Contrology (1945). Pilates teaching sites list them in the same fixed order, from the hundred to the push-up, each one preparing the next. The full list, in that order, is further down this page.

Sources 2, 3, 4, 5

Stories to read with care

Some popular pages call him an anatomist, date the method to 1926 as a way to rehabilitate war veterans, or say it began with springs fixed to hospital beds. The history published by the Pilates Method Alliance mentions none of these. It describes a circus performer and self-made trainer.

Source 2

The six principles

Many classes teach six principles. A systematic review defines them like this:

• Centering: tightening the muscles between the pelvic floor and the rib cage, often called the powerhouse.
• Concentration: the attention each exercise needs.
• Control: close management of posture and movement.
• Precision: accurate technique.
• Flow: smooth transitions from one movement to the next.
• Breathing.

Source 1

Where they come from

The six first appeared in a 1980 book by Philip Friedman and Gail Eisen, The Pilates Method of Physical and Mental Conditioning, more than a decade after Joseph Pilates died. A classical teaching platform says plainly that they do not come from him. They are a useful teaching framework, not the founder's own list.

Sources 6, 1

How much they matter to the research

The same review found the traditional principles mentioned in only about 23% of research papers, and apart from breathing they were absent from the low back pain trials. The trials that show a benefit mostly define Pilates by its exercises, not its principles.

Source 1

What modern schools teach instead

Contemporary schools teach practical basics. STOTT PILATES uses five: breathing, pelvic placement, rib cage placement, movement and stability of the shoulder blades, and head and neck placement. These are what a beginner needs, and they are the next section.

Source 7

Breathe out on the effort

Breathe in through the nose so the lower ribs widen to the sides and into the back, and out through pursed lips. This is often called lateral breathing. As a rule, breathe out on the effort or the curl, and in to prepare or to lengthen. Holding your breath is the mistake to watch for.

The hundred has its own rhythm: 5 arm pumps as you breathe in and 5 as you breathe out, ten times over.

Sources 7, 3

Neutral spine

Neutral keeps the natural small curve in your lower back. Lying on your back, your two hip bones and your pubic bone make a flat triangle, parallel to the floor. It is used for most work, especially with the feet on the floor.

Sources 7, 8

Imprint

Imprint is a slight tilt of the pelvis that eases the lower back toward the mat while the tailbone stays down. Many teachers use it when both legs are lifted, as in the hundred and the abdominal series, until the abs are strong enough to hold neutral. Schools differ, so treat it as an option, not a rule.

Sources 7, 8

Head and neck options

Keep your head down, on a small pad if your chin tips up; lift it with a slight nod and your gaze toward your knees; or rest its weight in your hands. Neck strain is a common complaint in the abdominal moves, so every curl-up on this site lists head down as its first easier option.

Source 7

What is different

Mat Pilates works your body weight against gravity with nothing but a mat. Long levers, such as straight legs or arms overhead, make it hard, and there is no spring to help. The reformer is a sliding carriage on springs, which can add resistance or give assistance. A Cleveland Clinic expert's view is that freeform mat work can be harder on the back than the reformer.

Sources 1, 9

Either works for back painMixed evidence

In a trial of 86 adults with chronic low back pain, 12 sessions of mat or equipment Pilates over 6 weeks gave the same pain relief. At 6 months, equipment Pilates was slightly better for disability and fear of movement. It is one small trial, and the Cochrane review pooled both kinds. Choose by access, cost and what you enjoy.

Sources 10, 11

How they differ

Yoga is a centuries-old practice with spiritual roots, and classes often end in meditation. Pilates is a 20th-century conditioning method built around core strength and control. Pilates usually moves through repetitions with breath cues, where yoga more often holds poses. A Cleveland Clinic doctor suggests Pilates if you need strengthening after an injury, and yoga if you want to learn to relax.

Source 12

Which is better for back pain?Mixed evidence

For chronic low back pain, Pilates ranks at or near the top of exercise types in three network meta-analyses, but the certainty is low. The authors of the largest suggest choosing an exercise you enjoy, so that you keep doing it.

Sources 13, 15, 16

Both count as strength work

NHS guidelines list both yoga and Pilates as muscle-strengthening activities. Many moves are cousins: the swan and cobra pose, the teaser and boat pose, the roll-over and plow pose, the mermaid and gate pose, rocking and bow pose.

Source 20

Two or three sessions a weekEmerging evidence

Most trials used 2 to 3 sessions a week. In a trial of 296 adults with back pain, once, twice or three times a week all helped compared with an advice booklet; twice beat once, and three times was not clearly better than twice, though it was the most cost-effective. A network meta-analysis found the most helpful programs used Pilates 1 to 2 times a week, in sessions under 60 minutes, for 3 to 9 weeks. In healthy adults, 2 to 3 sessions a week for 5 to 12 weeks improved abdominal endurance.

A good starting point is 2 to 3 sessions a week of 20 to 45 minutes. Once a week still helps.

Sources 17, 16, 18, 19

It counts as strength, not cardioStrong evidence

The NHS lists Pilates as a muscle-strengthening activity, recommended on at least 2 days a week alongside 150 minutes of moderate activity. Adults over 65 are advised to do strength, balance and flexibility work on at least 2 days a week. Pilates does not replace aerobic activity.

Sources 20, 21

Back pain: better than doing littleStrong evidence

For long-lasting, non-specific low back pain, a Cochrane review of 10 trials (510 adults) found Pilates reduced pain and disability compared with minimal intervention over the short and intermediate term. Three network meta-analyses, of 89 to 217 trials, rank Pilates at or near the top of exercise types for pain and disability.

Each review rated its certainty low to moderate, and the trials are small. The grade reflects how consistently the reviews agree, not the size of the effect.

Sources 11, 13, 15, 16

Better than other exercise? Not clearlyMixed evidence

Against other exercise, the Cochrane review found no clear difference in disability, mixed results for pain, and no conclusive evidence that Pilates is superior. The network meta-analyses rank it highly, with low certainty. One of them (Owen 2020) received an expression of concern from its journal, which the editors later withdrew, stating full confidence in the findings.

Other exercise works too, so the best choice is the one you will keep doing.

Sources 11, 13, 14, 15, 16

Core endurance, not extra strengthEmerging evidence

Across 9 trials in healthy people, Pilates improved abdominal endurance compared with no exercise, and a 12-week trial also found better upper-body endurance and hamstring flexibility. Compared with other exercise, such as strength training, stretching or yoga, it made no clear difference to strength or muscular endurance, at low to very low certainty.

Sources 18, 19, 22

Balance in older adultsEmerging evidence

Two reviews, of 39 and 20 studies, found Pilates improved balance in older adults, and the larger one also found better strength and fall-risk measures. Certainty was low for balance and moderate for strength and fall risk; the smaller review did not rate it, and blinding was often weak. A UK consensus on osteoporosis recommends balance and strength exercise, including Pilates, at least twice a week.

Sources 23, 24, 25

PostureMixed evidence

In healthy active adults, a 12-week trial found no change in posture. A 2024 review of 9 small studies, mostly in people with scoliosis or a rounded upper back, reported improvements, but study quality was moderate to low and the authors urge caution. Better posture is not a promise.

Sources 19, 26

Weight: a modest effectEmerging evidence

Across 11 trials in adults with overweight or obesity, mostly women, Pilates led to about 2.4 kg more weight loss and about 4 percentage points less body fat than doing nothing, at very low to moderate certainty. No trial compared it with other exercise.

It is light work for the heart: in an ACE-commissioned study, a beginner mat session reached about 54% of maximum heart rate and an advanced one about 62%, roughly like brisk walking. Reported calorie costs vary too much to quote a single figure.

Sources 27, 28, 29

Belly fat and tummy separation

Ab exercises do not burn fat from the stomach: in a small trial, six weeks of daily abdominal exercise did not reduce belly fat compared with no exercise. For tummy separation after pregnancy (diastasis recti), a review of 7 trials found very low-quality evidence for any specific exercise program, so Pilates is not proven to close the gap. A pelvic health physiotherapist can advise.

Sources 30, 31

Side effects are rareEmerging evidence

In the Cochrane review, adverse events were minor or absent, though only 2 of the 10 trials reported them.

Source 11

Osteoporosis or a past spinal fracture

A UK consensus advises avoiding sustained, repeated or end-range bending of the spine, especially under load. It says, "As a precaution, alternatives to exercises such as the 'roll down' and 'curl up' in Pilates should be considered", and that people who already move comfortably and smoothly can continue. Keep the back-extension moves.

The same consensus recommends balance and strength exercise, including Pilates, at least twice a week for everyone with osteoporosis, particularly at 65 or over or with poor balance.

Source 25

Neck problems

Skip the moves that put weight toward the neck: the roll-over, jack knife, control balance, boomerang, crab, high scissors and high bicycle. Use the head-down version of every curl-up.

Sources 4, 32

Pregnancy

Later in pregnancy, avoid lying flat on your back for more than a few minutes: swap those moves for side-lying, seated, kneeling or standing ones. Ask a professional before starting a new program.

Sources 34, 35

Recent surgery, new symptoms, or unsure

After recent surgery or a heart attack, with new symptoms, or if you are unsure about your fitness, speak to a GP or clinician first.

Source 35

Back pain

Some back pain is not a Pilates question. Get medical help for numbness around the genitals or anus, bladder or bowel changes, weakness in both legs, unexplained weight loss, a fever, or night pain.

If bending makes it worse, choose neutral-spine moves (dead bug, bird dog, bridge, side-lying work) and skip roll-ups and rolling. If arching makes it worse, keep the swan, swimming and kicks small, or skip them.

Sources 33, 25

Wrists, shoulders, knees and the lower back

Sore wrists or shoulders: use fists or forearms in plank work, and skip the leg pull back and the side bend. Knee problems: skip the kneeling side kick and pad any kneeling. After a lower back injury, the teaser is not recommended.

Source 4

"Long, lean muscles"

Exercise cannot lengthen a muscle: where it attaches is set by your genes, and muscle tissue is lean by nature. A leaner look comes from less body fat.

Source 36

"In 10 sessions you'll feel the difference"

This line, which goes on to promise a whole new body in 30 sessions, is widely attributed to Joseph Pilates. We found no primary source for it, and the wording varies from site to site. Treat it as a slogan, not a quote.

"Pilates burns belly fat"

No exercise burns fat from one spot. Pilates led to modest whole-body weight loss compared with doing nothing.

Sources 30, 27

"Pilates makes you taller"

Nothing suggests it changes your height. Posture can change how tall you stand, and even the posture evidence is mixed.

Sources 19, 26

"It's only for women or dancers"

Its founder was a male athlete and trainer, and trials include men, though most people in the weight-loss trials were women.

Sources 2, 27