Pilates guide
Pilates won't cure acid reflux, and no published study has tested it. But it doesn't have to make reflux worse either. What matters is position and timing: the NHS says reflux symptoms are often worse after eating, when lying down and when bending over, and a classical mat class spends a lot of time lying on your back, rolling and folding forward. In a lab study of 18 healthy women, no Pilates move pressed on the tummy much harder than standing up from a chair; the roll-up came closest and stayed high the longest.
So keep Pilates and change the parts that bring heartburn on: upright, side-lying and all-fours moves at any time, mat work on your back later after a main meal, and the roll-up, rolling, legs-overhead and face-down moves on an emptier stomach. This guide shows which moves to change and why, how long to wait after eating, what the breathing trials found, what helps reflux most (it isn't a Pilates move), the signs that heartburn needs a GP or 999, and a free 25-minute upright class. Pilates goes alongside the assessment and treatment of reflux, never instead of it.
Our searches found no published Pilates study in reflux, heartburn or hiatus hernia. The only one is a 33-person trial of standing clinical Pilates in Turkey, registered after it finished, with no results posted. Pilates isn't a treatment for reflux.
About 1 in 8 adults worldwide has heartburn or regurgitation every week. The NHS: "Symptoms are often worse after eating, when lying down and when bending over."
Losing weight if you're overweight, not eating within 3 or 4 hours of bed, raising the head of your bed, lying on your left side, and medicines from a pharmacist or GP.
Bending forward brought reflux on in people with reflux disease, and straining with a held breath set off reflux in 65% of people with daytime reflux. Upright, side-lying and all-fours Pilates suits any time; lying on your back, rolling and folding forward suit an emptier stomach (our reading).
Across 10 small trials, slow belly breathing modestly eased reflux symptoms, with very mixed results. Pilates rib breathing hasn't been studied in reflux, so do belly breathing as its own practice, sitting up.
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A heart attack can feel like indigestion. Chest pain or tightness on exertion is a 999 call, never something to put down to reflux.
The NHS: "Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). If it keeps happening, it may be called gastro-oesophageal reflux disease (GORD)." In the US it's GERD. Other symptoms include "an unpleasant sour taste in your mouth, caused by stomach acid", a cough or hiccups that keep coming back, a hoarse voice, bloating and feeling sick. Weekly symptoms affect 13.3% of adults across 102 studies, more often after 50.
What stops reflux is a ring of muscle at the bottom of the gullet (the oesophagus) working with the part of the diaphragm, the main breathing muscle, that wraps around it. Reflux mostly happens when that valve briefly relaxes, and more when pressure in the stomach rises or gravity stops helping.
The NHS lists some foods and drinks, being overweight, smoking, pregnancy, "stress and anxiety", some medicines such as anti-inflammatory painkillers, a stomach ulcer or infection, and a hiatus hernia, when part of your stomach moves up into your chest. A hiatus hernia is "very common if you're over 50" and doesn't need treatment if it isn't causing problems.
A classical mat class spends much of its time lying on your back (the hundred, curls, leg circles, bridges), and includes forward folds (spine stretch forward, the saw, roll-downs), the roll-up, rolling moves (rolling like a ball, the seal, the open-leg rocker), legs-overhead moves (the roll-over, the jack knife), face-down moves (the swan, swimming) and planks. For reflux, three things matter: position (lying flat, head-down or folded over your stomach), timing (a full stomach) and pressure (straining with a held breath). Pilates' slow pace, breathing out on the effort, and side-lying and all-fours work are on the right side of all three (our reading).
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In the bending study, people who also had reflux lying down refluxed during bending, while people with only daytime reflux didn't; in healthy people, a mild head-down tilt changed nothing. A move that bothers one person may not bother another, so keep what's comfortable.
No study has tested Pilates in reflux. The evidence below is about positions, pressure, exercise and breathing, mostly from small lab studies, and about the lifestyle changes that carry the treatment evidence.
Our searches of PubMed, Europe PMC and ClinicalTrials.gov in November 2026 found no published Pilates study in reflux. One randomised trial in Istanbul, of 33 adults with reflux disease doing 18 physiotherapist-led sessions over 6 weeks, finished in June 2025 and was registered in May 2026 with no results. Every exercise in it was standing, chosen to avoid bending forward or pressing on the tummy, and sessions were at least 2 hours after a main meal.
In 18 healthy, experienced women with a pressure sensor, no Pilates move's average peak was significantly higher than standing up from a chair 20 times. The roll-up came closest (about 50 against 56 cmH2O) and was the only move to keep pressure high for longer; bridging and reformer footwork were lowest. Side-lying had the lowest resting pressure. No one had reflux, and reflux wasn't measured.
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In 25 people with reflux disease, 30 minutes of toe-touching from lying, sitting and standing raised acid in the gullet during the exercise, mainly in those who also refluxed lying down, though only 2 felt symptoms. The toe-touch from lying is close to the Pilates roll-up (our reading).
In healthy volunteers who had just eaten, a 20-degree head-down tilt didn't change reflux. In 7 healthy people lying down, raising the legs on its own didn't cause reflux. Neither study was in people with reflux disease.
After a meal, straining against a held breath set off reflux in 65% of 23 people with daytime reflux, and in 44% of 10 people without it. That's the reason to breathe out on the effort in Pilates.
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In 20 healthy people after a fatty meal, reflux lasted 231 minutes lying on the right side against 117 on the left, and a device that discouraged right-side sleeping helped 44% of 100 people against 24% with a sham. A tight belt around the waist made reflux worse in people with reflux disease.
In small lab studies, running and weights brought reflux on, more after eating, and cycling least; light or short sessions didn't make a difference in people with reflux disease. Most mat Pilates is light to moderate effort (our reading).
Across 33 studies of 242,850 people, active people were about 20% less likely to have reflux disease, but most studies were snapshots in time, so they can't show that exercise was the cause.
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Across 10 small trials (476 people), slow belly breathing for about 20 minutes a session over about 5 weeks modestly improved symptom scores, with very mixed results and no clear change in quality of life; the authors say the evidence isn't enough for firm recommendations. In 19 people, 4 weeks of breathing training cut acid time from 9.1% to 4.7% in those who trained.
US gastroenterologists strongly recommend weight loss for people who are overweight. In 29,610 Norwegians, losing weight went with losing symptoms, and in a weight loss programme reflux fell from 37% to 15% of 332 people. Raising the head of the bed and lying on the left side helped in small trials, and eating dinner less than 3 hours before bed went with much more reflux disease. Medicines from a pharmacist or GP work too.
Upright Pilates and a walk are fine soon after a light meal. Leave about 2 hours after a main meal before lying on your back, rolling or folding forward. That's our suggestion, as on our exercise and yoga guides for reflux: no guideline gives a figure, but exercise brought on more reflux after eating in lab studies, and the one registered Pilates reflux trial used the same rule.
The NHS says don't eat within 3 or 4 hours of bed, and a 2024 international consensus advises leaving 3 hours between an evening meal and bed. If you do Pilates in the evening, finish upright or on your left side.
A light snack an hour or two before suits most people; a large or fatty meal just before a mat class tends to cause trouble (our suggestion, as on our exercise with acid reflux guide).
Not a list of banned moves: change these while reflux is bothering you, or do them on an emptier stomach. No study has tested any Pilates move in reflux, so each change is our reading, from the bending study, the pressure study and the NHS's advice.
Rolling like a ball, the seal, the open-leg rocker, the roll-over and the jack knife tip your head below your stomach. Do them on an emptier stomach or swap them for cat-cow (our reading). Our Pilates for bloating guide gives the same advice for the rolling moves.
The roll-up had the highest tummy pressure of 22 Pilates moves and folds you forward over your stomach. Do it later in the day, keep it small, or swap it for heel taps with your head down.
The hundred, double-leg stretch and criss-cross: keep your head down or swap for heel taps, on an emptier stomach (our reading).
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The swan and swimming press on a full tummy. Swap them for bird dog on all fours, or do them later in the day (our reading).
Spine stretch forward, the saw and standing roll-downs fold you over your stomach. Swap for a small hip hinge with a flat back, or sit tall and turn. Guts UK: "Try to avoid bending forward or wearing tight clothes as this can put extra pressure on your tummy."
Breathe out on the effort in planks, curls and lifts, and never brace with a held breath.
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Footwork and arm work lying on the carriage were among the lowest-pressure moves in the lab study, but they're still lying on your back, so time them away from meals. The reformer roll-up, short box rounding and inverted work are for an emptier stomach (our reading).
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Rolling, legs-overhead, roll-up, long curls, face-down and forward-fold moves: on an emptier stomach, or swapped for the moves below, while reflux is bothering you (our reading).
3D demoRolling like a ball (Pilates rolling back)Intermediate · No equipment
3D demoSeal (Pilates)Intermediate · No equipment
3D demoOpen-leg rocker (Pilates rocker with open legs)Advanced · No equipment
3D demoRoll-over (Pilates roll-over with legs spread)Advanced · No equipment
3D demoJack knife (Pilates)Advanced · No equipment
3D demoRoll-up (Pilates)Intermediate · No equipment
3D demoTeaser (Pilates)Advanced · No equipment
3D demoHundred (Pilates)Intermediate · No equipment
3D demoDouble-leg stretch (Pilates)Intermediate · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoSpine stretch forward (Pilates spine stretch)Beginner · No equipment
3D demoSaw (Pilates)Intermediate · No equipment
3D demoWall roll-down (wall Pilates)Beginner · A wallThese are our exercise with acid reflux guide's steps, word for word, built from the trials' routines. The effect was modest at best, and breathing adds to medicines and lifestyle changes rather than replacing them.
See the movement on the 3D figure: Slow breathing (6 breaths a minute)
Lateral breathing: "5 to 8 breaths at the start of every session" (the move page's dose), sitting tall with your waistband loose. Slow breathing: the belly-breathing steps above. Breath reach: "5 breaths, exhale longer than inhale" (the move page's dose), sitting.
Seated march: "1 to 2 minutes as a warm-up" (the move page's dose). Thoracic rotation: "6 rotations per side, moving with the breath" (the move page's dose), turning from the ribs. Seated side bend: "Hold 10 to 20 seconds, 2 or 3 times each side" (the move page's dose). Seated upper-back lift: "3 to 5 repetitions, each held 3 to 5 seconds" (the move page's dose). Sit to stand: 10; wall push-up: 10 to 15; slow calf raise: 15; standing march: 2 minutes, breathing out on each effort (our strength workout for acid reflux). Wall side leg lift: "10 to 12 each side" (the move page's dose). Mountain pose: "Stand for 5 to 10 slow breaths, 2 or 3 times" (the move page's dose).
3D demoSeated marchBeginner · A bench or box
3D demoThoracic rotationBeginner · No equipment
3D demoSeated overhead side bendBeginner · A bench or box
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box
3D demoSit to stand from a chairBeginner · A bench or box
3D demoWall push-upBeginner · A wall
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoSlow calf raiseBeginner · A wall
3D demoStanding marchBeginner · No equipment
3D demoMountain pose (Tadasana)Beginner · No equipmentClamshell: 10 each side (our Pilates for low blood pressure class); lie on your left side first, and if lying on your right side brings heartburn on, do that leg's work standing as a wall side leg lift (our suggestion). Side kick: "8 to 10 each side" (the move page's dose), head on your arm. Side-lying open book: "8 to 10 slow openings each side" (the move page's dose). Mermaid: "3 each direction, each side" (the move page's dose), sitting on a chair or cross-legged. Cat-cow: "8 waves, slower than feels natural" (the move page's dose), head level with your back. Bird dog, one limb at a time: 5 to 8 each side, holding 3 to 5 seconds (our strength workout for acid reflux).
3D demoClamshellBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSide-lying open bookBeginner · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipment
3D demoCat-cowBeginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipmentAbout 2 hours after a main meal (our suggestion); rest your head and shoulders on a firm wedge or cushions if lying flat brings symptoms on. Pelvic tilt into bridge: 8 slow; dead bug heel taps: 6 each side, head down (our Pilates for low blood pressure class). Knee fold: "2 sets of 5 to 10 each side, every other day" (the move page's dose). Heel slide: "10 slow repetitions each side, once or twice a day" (the move page's dose). Single-leg circle: "5 circles each direction, each leg" (the move page's dose), small.
Our exercise with acid reflux guide covers these in full.
The lifestyle change with the strongest evidence: the American College of Gastroenterology strongly recommends it. Programmes that worked combined eating less with more activity; Pilates can be part of the activity.
Don't eat within 3 or 4 hours of bed. The NHS suggests raising the head of your bed by about 10 to 20cm with wood, bricks or books, not extra pillows, and lying on your left side helped in small studies.
A pharmacist can suggest antacids or alginates, and a GP can prescribe stronger medicine. The NHS: "do not stop taking any prescribed medicine without speaking to a doctor first".
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Walking, cycling and swimming count towards the 150 minutes a week the NHS recommends; a 2024 consensus recommends moderate, regular exercise for people with reflux who are overweight. Upright Pilates adds strength and calm.
The same timing and changes apply. A hiatus hernia is very common over 50 and doesn't need treatment if it isn't causing problems. Our Pilates with a hernia guide covers hiatus hernias and recovery after surgery.
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Heartburn is common in pregnancy. The NHS suggests small meals often, sitting up straight when you eat and just after, and not eating within 3 hours of bed; upright and side-lying Pilates suit. Our Pilates in pregnancy guide covers the other changes.
In pregnancy, after the first trimester, keep time flat on your back to a few minutes: prop your upper body up, or use a side-lying or all-fours version.
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Our 25-minute upright class never lies you flat, rolls you or tips your head down: sitting, standing at a counter, then on your side and on all fours. No trial has tested it: its order and doses are our editorial choice, from the NHS's advice on positions and the Pilates pressure study. The yoga and strength classes are upright too; do the lying-down Pilates classes on an emptier stomach.
A 25-minute Pilates class for acid reflux: breathing sitting up, strength at a counter, side-lying and all-fours work, and no lying flat or head-down moves.
25 minBeginner18 movesA bench or box, A wallTwenty minutes of yoga that keeps your head above your heart: belly breathing sitting up, seated mobility, standing poses and a propped-up rest, nothing head-down.
20 minBeginner15 movesA bench or box, A wallA 25-minute upright strength workout for people with reflux: no lying flat, no head-down moves and no breath-holding, done about 2 hours after a main meal.
25 minBeginner12 movesA bench or box, A wallA 10-minute routine for straight after a meal: an easy walk, a few simple standing moves from blood sugar trials, then a short walk to finish.
10 minBeginner6 movesCardio machine, A bench or boxA 15-minute chair Pilates class done entirely sitting down, in a chair or wheelchair: breathing, spine moves, and leg and arm strength with water bottles.
15 minBeginner13 movesA bench or box, Something with weightA 20-minute chair Pilates workout for beginners and older adults: breathing, sitting tall, gentle spine and leg moves, and a standing finish at the chair.
20 minBeginner14 movesA bench or box, Something with weightA 20-minute Pilates class that never lies down, rolls or tips your head down: Pilates breathing and spine work in a chair, then legs and balance at a counter.
20 minBeginner16 movesA bench or box, A wallA 30-minute Pilates class for high blood pressure: standing strength, head-level mat work with short holds, no breath holds or inversions, and slow breathing.
30 minBeginner15 movesA bench or box, A wallThe walking plan builds to 150 minutes a week. The weight loss plan combines strength and cardio, if you're losing weight to ease your reflux.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner5 days a weekA 12-week workout plan for weight loss: three strength days, two cardio days and daily steps, building to 200 minutes a week, with honest results.
3 training days45 minBeginnerThe reflux lines are from our exercise with acid reflux guide, word for word, and the other lines from our Pilates guides. This is general information, not a diagnosis. A&E means accident and emergency; in the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111.
A heart attack can feel like indigestion, with a burning feeling in your chest, and NICE asks doctors to think about the heart when someone has indigestion. Stop exercising and call 999 if:
Chest discomfort that comes on with exercise needs a doctor, not an antacid (our suggestion). Don't drive yourself to accident and emergency (A&E). If you have chest pain with feeling sick, or a racing, slow, skipping or fluttering heartbeat, or you're suddenly more short of breath than usual, the NHS says call NHS 111 if it isn't a 999 emergency.
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The NHS says call 999 or go to A&E if you have a stomach ache and you're vomiting blood, your vomit looks like ground coffee, or your poo is black and sticky.
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If you have indigestion or reflux and:
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The NHS says see a GP if you have heartburn most days, or if medicines from a pharmacy and lifestyle changes aren't helping, and Guts UK says always see your GP if you've had heartburn most days for 3 weeks or more. Also see a GP for food getting stuck in your throat, a hoarse voice or a cough that isn't getting better, or a lump in your tummy. NICE asks GPs to refer anyone with difficulty swallowing, and anyone aged 55 or over with weight loss and reflux or tummy pain, for tests quickly.
Heartburn that doesn't go away with heartburn medicines can be a sign of pre-eclampsia, especially with a severe headache, problems with your vision, pain just below your ribs, or sudden swelling of your face, hands or feet. Call your maternity unit, or NHS 111 if you can't. See your midwife or GP for heartburn with difficulty swallowing, a hoarse voice, a cough that keeps coming back, weight loss, or pain or swelling in your stomach.
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Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.
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Stop a move that brings on heartburn and sit upright. Never put chest pain on exertion down to reflux: use the 999 lines above. Keep taking your medicines: Pilates goes alongside them (our suggestion, adapted from our yoga for acid reflux guide).
You feel any pain or become unwell, as the NHS advises for its Pilates videos, and especially for chest pain or pressure, unusual breathlessness, dizziness or fainting. If you have a health problem, an injury or any symptoms, get advice from a healthcare professional, such as a GP, before you start.
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The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.
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No published study has tested it. Weight loss if you need it, meal timing, raising the bed, lying on your left side and medicines are what work; Pilates goes alongside them.
The muscle that helps hold the valve shut is part of the diaphragm, and the trials that helped trained slow breathing, not the core. In one trial, aerobic exercise improved quality of life but not the valve's pressure.
No guideline says so. Active people have less reflux, and no Pilates move pressed on the tummy much harder than standing up from a chair. Change the position and the timing instead.
Reflux is often worse lying down after eating. Rest sitting up, or on your left side.
That claim, in a 2025 review, cites a general Pilates explainer, not a reflux study. The breathing with trial evidence is slow belly breathing, and its effect was modest.
A heart attack can feel like indigestion. Chest pain or tightness on exertion needs 999 or a doctor, not an antacid.
It can fit around the treatments that work, but no study has tested Pilates for reflux. Upright, side-lying and all-fours Pilates keeps you active without lying flat or folding over your stomach. Losing weight if you need to, meal timing, raising the bed and medicines do more.
Not in itself, but some parts of a class can bring heartburn on: lying flat soon after eating, bending forward, rolling or legs-overhead moves, lying face down on a full stomach, and holding your breath to strain. Change those for now rather than stopping Pilates.
It doesn't cause reflux disease, but a mat class soon after a big meal can bring on heartburn, mostly through position. Move the lying, rolling and forward-folding work to an emptier stomach, and breathe out on the effort.
While reflux is bothering you, do the roll-up, rolling like a ball, the seal, the open-leg rocker, the roll-over and jack knife, deep forward folds and face-down moves on an emptier stomach, or swap them. None is banned: if one doesn't bother you, keep it.
Seated breathing and spine moves, standing moves at a counter, and side-lying and all-fours moves such as the side kick, clamshell, cat-cow and bird dog. None has been tested for reflux; our 25-minute upright class puts them together.
Upright moves and a walk are fine soon after a light meal. We suggest leaving about 2 hours after a main meal before lying on your back, rolling or folding forward; no guideline gives a figure. Don't eat within 3 or 4 hours of bed.
Yes, with the same changes. Footwork and arm work on the carriage put little pressure on the tummy, but you're lying on your back, so time them away from meals; leave the reformer roll-up and inverted work for an emptier stomach.
It hasn't been tested. Slow belly breathing modestly eased symptoms in small trials, so do it as its own practice, sitting up, for 5 to 10 minutes once or twice a day, alongside your other treatment.
There's no evidence it does. The muscle that helps hold the valve shut is part of the diaphragm, and the trials that helped trained breathing, not the core. Pilates is good general strength work, not a reflux treatment.
Usually yes, with the same timing and changes. A hiatus hernia is very common over 50 and doesn't need treatment if it isn't causing problems; our Pilates with a hernia guide covers it in more detail.
Usually it's the position (lying flat, head-down or folded forward) on a full stomach, or holding your breath during an effort. Sit upright, loosen your waistband and change the move next time. Chest pain or tightness on exertion can be your heart: call 999.
If you have heartburn most days, or pharmacy medicines and lifestyle changes aren't helping. Get an urgent appointment or call NHS 111 if swallowing becomes difficult, you lose weight without trying, or you're being sick often or there's blood in your sick. Call 999 for vomiting blood or black, sticky poo.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
