Pilates guide
Exercise is one of the main treatments for arthritis, and Pilates is one gentle, low-impact way to do it: the NHS lists it among the activities that suit arthritis and has a Pilates class for it. In trials in knee osteoarthritis, Pilates eased pain more than doing nothing and about as much as other exercise; in ankylosing spondylitis, small trials found it helped.
For hip, back and hand arthritis, and for rheumatoid arthritis, there's little research on Pilates itself, but the case for exercise in general still holds, and the moves are easy to adapt for sore knees, hips, hands and necks.
This guide covers what the trials found for each kind of arthritis, how much pain is all right, the moves to start with and how to adapt them, what to do in a flare, and the warning signs that need help the same day. Our 25-minute Pilates for arthritis class has no kneeling and no weight on your hands.
The National Institute for Health and Care Excellence (NICE) says to offer exercise to everyone with osteoarthritis, and that exercise "is not harmful to osteoarthritic joints". The American College of Rheumatology strongly recommends regular exercise in rheumatoid arthritis, and NICE recommends a structured exercise programme in axial spondyloarthritis, which includes ankylosing spondylitis.
The NHS lists Pilates among the low-impact activities that suit arthritis, and Arthritis UK counts it as strengthening and balance work. No guideline names Pilates, and the American College of Rheumatology found no reason to prefer one type of exercise over another.
In small trials, Pilates eased knee pain more than no exercise, and about as much as other exercise programmes.
Our arthritis guide counts pain of 0 to 2 out of 10 as safe and up to 5 as acceptable if it has settled by the next morning. Hot or swollen joints need a rest from strengthening until they settle.
Use lying, side-lying and chair versions, keep your head down if rheumatoid arthritis affects your neck, and follow your team's limits after a joint replacement. In a flare, do less, not nothing.
The NHS describes arthritis as a condition that causes pain, swelling and stiffness in one or more joints. Osteoarthritis is the most common type and often affects weight-bearing joints such as the knees; rheumatoid arthritis is usually first felt in the small joints of the hands and feet; ankylosing spondylitis often causes lower back pain and stiffness that lasts longer than ordinary backache. Symptoms can flare up for several days at a time.
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For osteoarthritis, NICE recommends therapeutic exercise tailored to the person, such as local muscle strengthening and general aerobic fitness, and suggests considering supervised sessions; it says joint pain may increase when you start and that regular exercise will still help. For rheumatoid arthritis, NICE recommends physiotherapy to improve fitness, flexibility and muscle strength. For axial spondyloarthritis, it recommends a structured programme with stretching, strengthening and posture exercises, deep breathing, spinal extension, range-of-motion exercises for the whole spine, and aerobic exercise. International osteoarthritis guidelines put structured exercise at the centre of care, and European rheumatology recommendations make physical activity part of standard care in arthritis.
No guideline names Pilates. The American College of Rheumatology found "insufficient evidence to recommend one form of exercise over another" in osteoarthritis, and said mind-body practices other than tai chi and yoga couldn't be assessed; in rheumatoid arthritis it gives a conditional recommendation to mind-body exercise, which improved function but not pain. The NHS, Arthritis UK, the National Rheumatoid Arthritis Society and the National Axial Spondyloarthritis Society all list Pilates as a suitable option, and the NHS has a 32-minute Pilates class for arthritis.
In the knee trials, classes ran 2 or 3 times a week for 6 to 10 weeks, and the commonest moves were the hundred, single-leg stretch, double-leg stretch, clam and shoulder bridge; most trials didn't describe how hard the work was or how it progressed. Trials in ankylosing spondylitis used sessions 3 times a week for 8 to 12 weeks.
In a 2024 Cochrane review of 139 trials in knee osteoarthritis, exercise reduced pain by about 9 to 13 points out of 100 and improved function by about 11 to 13 points, compared with placebo or usual care. In a 2026 review of 18 hip studies, pain fell by about 7 points against no treatment. The reviewers judged these average effects small or of uncertain importance; NICE recommends exercise for everyone with osteoarthritis.
A 2025 review of 11 trials (476 people) found Pilates reduced knee pain more than no exercise (3 trials, 66 people, low certainty) but not more than conventional exercise (5 trials, 210 people, very low certainty). Another review of 8 trials found the same pattern, with signs that small studies with negative results may be missing. The trials were small and short, and few reported side effects.
One network meta-analysis found large effects of Pilates on knee pain and function against usual care and rated the evidence moderate certainty, but that rests on just 2 small Pilates trials. Another, of 29 trials, ranked Pilates first for knee function, with no significant effect on pain, at low or very low certainty.
We found no published trial of Pilates in hip osteoarthritis; one finished in June 2025 with no results posted. For back pain in general, a Cochrane review of 10 trials found Pilates eased pain and disability more than minimal treatment and about as much as other exercise, at low to moderate quality, and a review of exercise for worn spinal discs found no clear differences between types. We found no Pilates trials in spinal arthritis or hand arthritis.
In small trials of 20 to 96 people, Pilates improved disease activity and everyday function more than usual care or home exercise, and adding Pilates to aerobic training helped more than aerobic training alone. In a review of 15 studies of mind-body exercise, 4 of them Pilates, function and disease activity scores improved, at moderate to low certainty, with no serious side effects.
In a 2026 network meta-analysis of 59 trials, which we could read only as an abstract, Pilates improved disease activity, function and pain against usual care, but no type of exercise improved spinal mobility. Another network analysis ranked aerobic exercise plus Pilates first for disease activity and spinal mobility, and the review of mind-body exercise found a small gain in mobility. Whether Pilates beats other structured exercise isn't known.
There are only two small Pilates trials, of 30 people each: in one, Pilates, aerobic exercise and both together didn't differ; in the other, pain and knee strength improved more than in a control group. A network meta-analysis ranked Pilates first for pain, but on one of these trials, whose own Pilates group didn't improve significantly, so we don't rely on it. Regular exercise of any kind is the recommendation.
In two small trials, of 50 and 40 children, Pilates on its own or added to physiotherapy improved quality of life, pain and function more than conventional exercise or physiotherapy alone.
Only 2 of 11 knee trials reported side effects (none, or none serious), and reviewers noted that monitoring was limited. Exercise in general may bring more minor aches than usual care.
Arthritis UK suggests strengthening on at least two days a week and balance work on two days, with walking, cycling or swimming as well. The Pilates trials used 2 or 3 sessions a week for 6 to 12 weeks. Supervised sessions help, the American College of Rheumatology and NICE say: a physiotherapist-led class, or a teacher who knows about your arthritis.
Some pain is all right. Our arthritis guide counts pain of 0 to 2 out of 10 as safe and up to 5 as acceptable if it has settled by the next morning. The 0 to 2 and up to 5 bands come from a training programme for severe hip and knee osteoarthritis, where 93% of sessions stayed at acceptable pain or below; across long-term muscle and joint pain, exercising into some pain did no worse than pain-free exercise.
Arthritis UK says that if your joints are hot or swollen, "it's sometimes a good idea to focus on stretching exercises and avoid strengthening exercises until they settle down". The NHS: if an activity makes your joints warm and swollen or causes severe pain, stop and rest.
Mat, chair and reformer classes can all work; tell the teacher about your arthritis. The National Axial Spondyloarthritis Society says Pilates classes are low impact and "less likely to lead to a flare". In one trial of 20 people with ankylosing spondylitis, reformer Pilates beat mat Pilates for disease activity, too small a study to say the reformer is better.
Lying, side-lying, chair and standing moves, with no kneeling and no weight on your hands. Keep your head down in the hundred and the single-leg stretch, keep circles small, and use the doses in our Pilates for arthritis class below, which includes all of these moves.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoHundred (Pilates)Intermediate · No equipment
3D demoSingle-leg stretch (Pilates one leg stretch)Intermediate · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoSit to stand from a chairBeginner · A bench or box
3D demoSpine twist (Pilates)Beginner · No equipment
3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoSingle-leg standBeginner · A wallBending back, turning and side bending, as NICE recommends for axial spondyloarthritis. Keep each move small and smooth, and do the mermaid on a chair if side-sitting is hard.
Breathing and gentle range for days when your joints are sore: a few slow repetitions of each, then build back up over the following days.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment3D demoSupine heel slideBeginner · No equipment
3D demoAnkle CARs (controlled articular rotations)Beginner · No equipment
3D demoHip windshield wipersBeginner · No equipment3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment
3D demoSeated marchBeginner · A bench or boxWith painful knees, pad or skip kneeling moves such as the knee hover, bird dog and kneeling side kick, and sit on a chair for the mermaid. After a knee replacement, the NHS says not to kneel on the new knee until your doctor says you can, and not to sit with your legs crossed for the first 6 weeks.
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While a new hip recovers, the NHS advises not bending it more than 90 degrees, not crossing your legs, not bending down to touch your feet, and avoiding jumping and sudden turns. That rules out the roll-up, the teaser and the rolling moves, a deep knee-to-chest in the single-leg stretch, and the inner thigh lift, which crosses one leg over the other. Keep leg circles small, and follow your own team's limits.
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Make fists or use your forearms, or swap planks, leg pulls, the side bend and push-ups for lying or chair moves. For hand pain in rheumatoid arthritis, NICE recommends a tailored hand exercise programme from a trained practitioner; tendon glides keep the fingers moving.
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Long-standing rheumatoid arthritis can, uncommonly, damage the joints at the top of the neck, which the NHS calls a serious condition. Keep your head down in curl-ups, and leave out moves that put weight on your neck: the roll-over, jack knife, control balance and boomerang.
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Ankylosing spondylitis can cause osteoporosis in the spine and raise the risk of spinal fractures. With osteoporosis or a spinal fusion, check with your physiotherapist first, and avoid deep, repeated or loaded rounding of the spine; the National Axial Spondyloarthritis Society suggests low weights and high repetitions.
The National Rheumatoid Arthritis Society's steps: relative rest, doing less than usual; ice or heat for 15 to 20 minutes; keep the joints moving; return gently, with only a few repetitions; then gradually work back. Arthritis UK suggests slow, gentle movement rather than stopping, cutting the load first and then the number of sets, and never forcing a movement.
Leave strengthening until hot or swollen joints settle, and keep to breathing and gentle range, such as heel slides, ankle circles and hand glides. High-intensity, high-impact or high-volume exercise is the most likely to aggravate symptoms. A flare can last several days; if an activity always brings one on, avoid it.
Start with the 25-minute Pilates for arthritis class twice a week. The knee and hip classes focus on one joint, chair Pilates suits days when the floor is hard, and the flare-up routine suits bad days.
A gentle 25-minute Pilates class for arthritis: lying, side-lying, chair and standing moves, with no kneeling or weight on your hands, and flare-day options.
25 minBeginner16 movesA bench or box, Something with weightA 25-minute Pilates class for sore knees and knee arthritis: lying and side-lying leg work, shallow squats and balance, with no kneeling at all.
25 minBeginner15 movesA bench or box, Something with weightA 20-minute Pilates class for hip pain: bridges, outer-hip holds, standing leg work and balance, without deep bends, crossed legs or lying on the sore side.
20 minBeginner14 movesA band, A wallA 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 15-minute routine of the exercises NHS physiotherapy Pilates classes send home: bridge, knee folds, leg slides, clam, side kick and side openings.
15 minBeginner10 movesNo equipmentA 10-minute routine for a pain flare-up: slow breathing, small gentle moves lying and sitting, a short stroll if you can, then rest. Repeat later in the day.
10 minBeginner10 movesA band, A bench or boxA 30-minute joint-friendly circuit built like the GLA:D and ESCAPE-pain programmes: a gentle warm-up, chair, step and band strength moves, balance, then stretches.
30 minBeginner14 movesA bench or box, A stepA 30-minute joint-friendly yoga class for arthritis: seated breathing and joint warm-ups, standing poses with a chair, gentle lying poses and a long relaxation.
30 minBeginner17 movesA bench or box, A wallThe seniors plan adds walking, strength and balance through the week; the beginner Pilates plan builds a habit of 3 short classes a week.
A 12-week exercise plan for over-65s: strength and balance three times a week, short balance sessions and daily walks, based on falls-prevention trials.
3 training days40 minBeginner3 days a weekA free 4-week, 3-day Pilates plan for complete beginners. Two mat days and one wall day, with clear rules for when to move each exercise to its harder version.
3 training days25 minBeginnerAsk for an urgent GP appointment or get help from NHS 111. In the US, use your doctor's urgent line or urgent care.
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In the US, call 911. These can be signs of cauda equina syndrome, when the nerves at the bottom of the spine are squashed: very rare in ankylosing spondylitis, but an emergency.
If you've had rheumatoid arthritis for some time, you're at higher risk of a problem at the top of the spine called cervical myelopathy, uncommon but serious. Our rheumatoid arthritis guide lists the warning signs that need help the same day.
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In many areas you can refer yourself to NHS musculoskeletal (MSK) services, such as physiotherapy, without seeing a GP first.
NICE wanted "to reassure people with osteoarthritis and healthcare professionals that exercise is not harmful to osteoarthritic joints", and the NHS calls exercise one of the most important treatments for osteoarthritis. Exercise is strongly recommended in rheumatoid arthritis too.
In knee osteoarthritis, Pilates was better than no exercise but not better than other exercise programmes, and the American College of Rheumatology found no type of exercise better than another.
Some pain when you start is common and isn't a sign of harm if it settles. A hot, swollen joint is different: rest it from strengthening.
The arthritis charities advise relative rest with gentle movement, then a gradual return. The NHS says that without movement, joints stiffen and muscles get weaker.
The knee trials mostly used mat classes, and the NHS class uses a mat and a cushion. One small trial in ankylosing spondylitis favoured the reformer, too small to generalise from.
Yes, as one way to do the exercise that's a core treatment for arthritis. The NHS lists Pilates among the low-impact activities that suit arthritis, and Arthritis UK counts it as strengthening and balance work. In trials it's better than no exercise and about as good as other exercise.
In knee osteoarthritis, Pilates reduced pain more than no exercise in small trials, and as much as other exercise programmes. The trials were short and small, so the certainty is low. Our Pilates for knee pain guide has a class with no kneeling.
No Pilates trial in hip osteoarthritis has been published yet. Exercise in general helps hip osteoarthritis a little, and Pilates' lying, side-lying and standing hip work is a sensible way to do it. After a hip replacement, follow your team's limits on bending and crossing your legs.
There are no Pilates trials in spinal arthritis itself. For back pain in general, Pilates helps about as much as other exercise, and NICE suggests group exercise programmes, including mind-body ones. Keep rounding moves gentle, and avoid deep or repeated rounding if you also have osteoporosis.
Possibly, but there are only two small trials. Exercise is strongly recommended in rheumatoid arthritis, and mind-body exercise improved function more than pain in the American College of Rheumatology's review. If rheumatoid arthritis affects your neck, keep your head down and leave out moves that put weight on it.
Small trials found Pilates improved disease activity and everyday function more than usual care or home exercise, and the National Axial Spondyloarthritis Society lists Pilates classes as an option. Reviews disagree on whether any exercise improves spinal mobility. Check with your physiotherapist first if you have a spinal fusion or osteoporosis.
Exercise doesn't harm arthritic joints, NICE says, and Pilates trials reported few side effects, though most didn't check carefully. Some aching is normal; if a joint becomes hot, swollen or much more painful, stop and rest it.
Keep moving gently: do less than usual, use heat or ice, and keep your joints moving through a comfortable range. Leave the strengthening moves until the joint settles, then come back with a few repetitions.
Any can work: the knee trials mostly used mat classes, the NHS class uses a mat and a cushion, and chair Pilates avoids getting down to the floor. Tell the teacher about your arthritis, whichever you choose.
The trials used 2 or 3 sessions a week for 6 to 12 weeks. Arthritis UK suggests strengthening on at least two days a week and balance work on two days, with walking, cycling or swimming as well.
No trial has compared them in arthritis, and the American College of Rheumatology found no reason to prefer one type of exercise over another. Pick the one you'll keep doing; our yoga for arthritis guide covers yoga.
No Pilates trial has studied hand arthritis. Gentle hand exercises such as tendon glides keep the fingers moving, and NICE recommends a tailored hand programme for hand pain in rheumatoid arthritis. In Pilates, use fists or your forearms instead of flat hands if your wrists or fingers hurt.
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.
