Pilates guide
Pilates is a safe and sensible way to stay active when your asthma is well controlled, and European guidance on exercise in asthma names it for core strength and flexibility, alongside aerobic and strength exercise. It isn't a treatment for asthma: the few Pilates studies are tiny, mostly unpublished, and none has shown better lung function or fewer attacks. If any exercise brings on coughing, wheezing or a tight chest, that's usually a sign your asthma needs a review.
This guide covers what Pilates breathing is and how it differs from the breathing exercises physiotherapists teach for asthma, your inhaler and warming up, hot classes and other triggers, steroid tablets and your bones, the moves to change, the classes to follow, and what to do in an asthma attack.
A 2025 European position paper on exercise in asthma names Pilates for core strength and flexibility, alongside aerobic and strength exercise. Exercise in general is well tolerated in asthma, and it improves fitness and asthma control.
There's no systematic review of Pilates in asthma. The handful of studies are tiny and mostly unpublished, and none has shown, against a fair comparison, better lung function, better asthma control or fewer attacks.
Physiotherapy breathing programmes improve quality of life a little, but not lung function or attacks. The Pilates breath is a way to breathe steadily through effort, never holding your breath.
If Pilates, or any exercise, brings on coughing, wheezing or a tight chest, Asthma + Lung UK says that's usually a sign your asthma isn't as well controlled as it could be. Use your reliever before exercise only as your action plan says.
The NHS says to always have your inhaler with you. Know what to do in an asthma attack: the steps are at the end of this guide.
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Breathe at your own pace in the hundred, skip breath holds when you have symptoms, warm up properly before harder classes, choose a room at normal temperature if heat is a trigger, and use the osteoporosis versions of moves after long courses of steroid tablets.
Asthma is a common condition that affects your breathing. The NHS says it "cannot currently be cured, but if it's well treated you should not have problems with symptoms". Wheezing, coughing, breathlessness and a tight chest come and go, and exercise, cold air, air pollution and allergies can set them off. Treatment is mainly inhalers, set out in a personal asthma action plan, with a review at least once a year.
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When you breathe fast through your mouth, especially in cold, dry air, your airways can narrow during or just after exercise. Doctors call this exercise-induced bronchoconstriction (EIB). In 7 randomised studies, warm-ups with short hard bursts reduced it, while steady warm-ups made no significant difference.
Mat Pilates is light to moderate activity, as our heart health Pilates guide explains. Our reading, which no study has tested: a gentle mat class is less likely to set off EIB than running in cold air, because your breathing stays slower. Fast reformer, jumpboard and "Pilates HIIT" classes are harder work, so treat them like any other hard exercise.
Contemporary Pilates schools such as STOTT PILATES teach breathing in through the nose and out through pursed lips, widening the back and sides of the ribs, and breathing out deeply to help the deepest tummy muscle work. It's a way of teaching movement, not a treatment. Asthma breathing retraining is different: slow, low, relaxed breathing, usually through the nose, with a longer breath out, taught over several sessions.
In 136 adults with severe asthma, back and side-trunk endurance was poorer than in 66 people without asthma, and poorer core tests went with more breathlessness and breathing-pattern symptoms. That's a link, not proof that core training helps.
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Pilates itself is barely tested in asthma. The evidence that matters comes from exercise in general and from breathing retraining, and medicines remain the main treatment.
In a Cochrane review of 21 trials (772 people over 8 years old), physical training raised fitness and was "well tolerated with no adverse effects reported". Lung function didn't change.
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In adults, 8 to 12 weeks of aerobic training improved asthma control (11 trials, 543 people). Pulmonary rehabilitation added about 80 metres to a 6-minute walk (moderate certainty) and improved asthma control a little (low certainty).
Our searches found no systematic review of Pilates in asthma, and an overview of 34 reviews of exercise in asthma included none. In 26 Iranian women, quality of life and symptoms improved after 8 weeks of modified Pilates (a Persian paper; we read its English summary). In about 48 adults in Pakistan, the group that added 5 Pilates moves to breathing-muscle training walked further and had better symptom scores after training, but walking wasn't reported at the start and the paper has several inconsistencies. In 47 Brazilian children, breathing muscles got stronger after 12 weeks, in a thesis not published in a journal. A Portuguese master's thesis studied 7 adults. A registered Brazilian trial of 30 adults finished in 2018 with no results published.
So people may feel and function better, at very low certainty.
No study has shown, against a fair comparison group, that Pilates improves lung function, asthma control or attacks.
The European Academy of Allergy and Clinical Immunology (EAACI) suggests "interventions such as yoga and/or Pilates" for core strength and flexibility, "alongside aerobic and resistance-based exercise", partly because poorer core function goes with worse breathing symptoms in severe asthma. It cites no Pilates trial for this.
Breathing exercises improved asthma quality of life at 3 months by a small amount (moderate certainty), in a Cochrane review of 22 trials (2,880 adults) with no Pilates trial among them. In the UK BREATHE trial of 655 adults, a physiotherapy DVD and booklet worked as well as face-to-face sessions. UK guidance says breathing exercise programmes "can be offered to adults with asthma as an adjuvant to pharmacological treatment to improve quality of life and reduce symptoms".
The Global Initiative for Asthma (GINA) says breathing exercises "do not improve lung function or reduce exacerbation risk".
Small Pilates studies report stronger breathing muscles, mostly without a comparison group or blinding. A review of 9 exercise trials in older adults, Pilates among them, found no significant change in breathing-muscle strength or peak flow.
No trial has compared Pilates with other exercise in asthma. In healthy adults, Pilates improved fitness (12 trials, very low to low quality), but it "was not different from other exercises".
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In a Turkish trial of 40 adults who all had asthma education and breathing retraining, adding 6 weeks of core stabilisation twice a week improved breathing-muscle strength, walking distance and balance a little more.
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Breathe in through your nose if you can, and out through slightly pursed lips as you work. Never hold your breath to get through a move: if you catch yourself holding it, make the move smaller (our suggestion).
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The classical hundred breathes in for 5 arm beats and out for 5. If that leaves you short of breath, breathe at your own pace, and rest your head if your neck tires (our suggestion).
Box breathing and 4-7-8 breathing include holds. Our exercise with asthma guide says: "Skip breath-hold techniques when you have symptoms (our suggestion)." The BREATHE programme taught some controlled holds when people were well, so they aren't banned outright.
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If a breathing practice makes you dizzy, light-headed or tingly, you're probably breathing too deeply: make the breaths smaller or go back to normal breathing. If you get wheezy or tight-chested, stop and follow your action plan (our suggestions).
If breathlessness or symptoms bother you, ask your GP or asthma nurse about a physiotherapy breathing programme. Our yoga for asthma guide covers the Buteyko and Papworth methods.
Breath of fire and other fast, forceful breathing have no place in a Pilates class for asthma: our yoga for asthma guide leaves them out, because fast breathing caused more side effects in trials.
Take your reliever before exercise only if your asthma action plan says to. If you need it for exercise most of the time, or symptoms break through anyway, ask your GP or asthma nurse for a review, as our exercise with asthma guide explains.
Keep your reliever within reach of your mat, not in a bag across the room (our suggestion).
Asthma Australia's respiratory physiotherapist notes that "asthma symptoms can occur up to half an hour after exercise", so keep it with you after class too (our suggestion).
Pilates classes usually start gently, and in our reading a gentle mat class is unlikely to bring on exercise-induced symptoms; no study has tested this. Before a harder class, such as fast reformer, jumpboard or Pilates HIIT, or any session that has brought on symptoms before, use our asthma warm-up, which follows the trials of short hard bursts.
Reformer classes can be harder work than a beginner mat class. Start at a beginner level, with your reliever beside the machine (our suggestion).
Asthma + Lung UK says "Hot and humid air can affect your breathing and make asthma and other lung condition symptoms like breathlessness and wheezing worse". No study has tested hot Pilates in asthma. If heat is a trigger for you, choose a room at normal temperature (our suggestion).
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Asthma + Lung UK says "If you're exercising in a gym, or doing exercises on the floor, dust could trigger your symptoms", and the NHS lists smoke among triggers. Use your own clean mat, and choose a class without incense or strong scents if they set you off (our suggestion, as on our yoga for asthma guide).
The NHS lists "taking high-dose steroid tablets for more than 3 months" among risk factors for osteoporosis, and the Royal Osteoporosis Society says steroid tablets "are more likely to cause bone loss if you take them for more than three months, or if you often take a short course of them". If you've been told your bones are thin, use the head-down versions of curl-ups and skip roll-ups and roll-downs, as the moves' osteoporosis cautions say; if you've needed many courses, ask your GP whether you need a bone check (our suggestion).
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.
If you're pregnant, the NHS asks you to tell your doctor or midwife about your asthma.
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A reliever that doesn't help, noise on the breath in and a tight throat can be a different problem, inducible laryngeal obstruction, which our exercise with asthma guide covers.
Slow breathing: "At least 5 minutes, done regularly as part of your daily routine" (the move page's dose), in through your nose with a longer breath out, close to the breathing retraining in the asthma trials. Lateral breathing: "5 to 8 breaths at the start of every session." (the move page's dose). Crocodile breathing, optional: "5 minutes of easy nose breathing, about 4 seconds in and 6 out (our editorial starting point)" (the move page's dose); sit up with your hands on your lower ribs if lying face down feels tight.
Standing march: 2 minutes at an easy pace (our high blood pressure Pilates class's warm-up). Breath reach: "5 breaths, exhale longer than inhale" (the move page's dose). Cat-cow: "8 waves, slower than feels natural" (the move page's dose). Before a harder class, use the 15-minute asthma warm-up instead.
Pelvic tilt into bridge: 8 slow, breathing out as you lift; clamshell: 10 each side; bird dog: 5 each side, holding each for up to 3 breaths (all our high blood pressure Pilates class). Chest lift: "8 to 10 reps." (the move page's dose), breathing out as you curl up. Hundred: "50 beats to start, building to 100 (the classical count)." (the move page's dose), at your own breathing pace (our suggestion). Single-leg stretch: "6 to 10 each side." (the move page's dose). Single-leg circle: "5 circles each direction, each leg (the classical sequence uses 5)." (the move page's dose). Side kick: "8 to 10 each side." (the move page's dose). Swan: "5 to 6 reps." (the move page's dose), breathing in as you lift and out as you lower (our suggestion).
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoChest lift (Pilates curl-up)Beginner · 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 demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipmentSpine twist: "3 to 4 each side (the classical sequence uses 3)." (the move page's dose). Mermaid: "3 each direction, each side." (the move page's dose). Slow breathing: 5 minutes sitting, about 4 in and 6 out, with no holds (our high blood pressure Pilates class's finish).
If breathing in for 5 beats and out for 5 leaves you short of breath, breathe at your own pace, do it propped up, or leave it out on days your chest feels tight (our suggestion).
Skip the holds in box and 4-7-8 breathing when you have symptoms, as our exercise with asthma guide says.
Prop your head and shoulders up on cushions or work on your side, as our corpse pose page suggests for anyone who gets breathless lying flat.
If you've been told your bones are thin, use head-down versions of the chest lift and the hundred, and leave out roll-ups, roll-downs and legs-overhead moves, as those moves' osteoporosis cautions say.
If they set you off: a room at normal temperature, your own clean mat and a class without incense (our suggestion).
Our head-up Pilates class for high blood pressure was written for blood pressure, but its steady breathing and lack of breath holds suit asthma too (our suggestion). The beginner class is the foundation: breathe at your own pace in the hundred. Use the asthma warm-up before harder sessions or any that bring on symptoms. Wall Pilates starts upright. The yoga for asthma practice's first two blocks make a breathing practice for other days, and in the breathing routine, skip the box and 4-7-8 holds when you have symptoms.
A 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 wallA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentA 15-minute warm-up for exercise-induced asthma: easy movement, then short hard bursts that can reduce symptoms in the session that follows, then moving stretches.
15 minBeginner5 movesCardio machine, A wallA 20-minute beginner wall Pilates workout: standing and floor moves that use a wall for support and feedback. No equipment.
20 minBeginner9 movesA wallA 20-minute yoga practice for asthma: slow nose and belly breathing first, then gentle stretches and standing poses, with no breath holds or fast breathing.
20 minBeginner12 movesFirm cushionA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentThe asthma attack steps, the 999 list and the GP list are from our exercise with asthma guide, word for word; the chest pain, stop and before-you-start lines are the ones our other Pilates guides use. 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.
Sit up straight and try to stay calm. Then:
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Call 999 (911 in the US) if you or someone else is having an asthma attack and:
If you're no better after 10 minutes and the ambulance hasn't arrived, use your inhaler again, up to the same maximum dose. If you're still no better and it still hasn't arrived, call 999 again straight away. Don't drive yourself to A&E.
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See a GP within 2 days, even if you feel better. Asthma + Lung UK suggests a same-day appointment if you managed the attack yourself. Don't exercise again until your symptoms and breathing have recovered.
Carry your reliever every time. Stop the session if symptoms don't settle, and call 999 if your breathing doesn't go back to normal after exercise.
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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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Asthma "cannot currently be cured", the NHS says. Breathing retraining improves quality of life a little, but breathing exercises "do not improve lung function or reduce exacerbation risk", and no Pilates study has shown better asthma control or fewer attacks.
The story is popular, but the Pilates Method Alliance's history and a profile drawing on two biographies and camp records don't mention asthma; the profile says only that he grew from "a weakling child to a strong young man". Even if it were true, one man's story wouldn't show that Pilates treats asthma.
Exercise doesn't make adult lungs bigger: fitter muscles make the same effort feel easier, as our lung capacity guide explains. Training didn't change lung function in the asthma trials, and the Pilates studies show breathing-muscle changes at most.
Symptoms with exercise usually mean your asthma isn't as well controlled as it could be: the answer is a review, not stopping. Training is well tolerated and improves fitness and asthma control.
No study supports it, and Asthma + Lung UK says hot and humid air can make asthma symptoms worse.
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Follow your action plan. Needing your reliever for exercise most of the time is a reason for an asthma review, and taking a short-acting reliever regularly makes it work less well, as our exercise with asthma guide explains.
Pilates is a safe, sensible way to stay active when your asthma is well controlled, and European guidance names it for core strength and flexibility alongside aerobic and strength exercise. It hasn't been shown to improve asthma itself: the few Pilates studies are tiny, and none showed better lung function or fewer attacks. Exercise in general is well tolerated and improves fitness and asthma control.
Yes, if your asthma is well controlled: keep your reliever within reach of your mat and follow your action plan. If Pilates or any exercise brings on coughing, wheezing or a tight chest, that usually means your asthma needs a review. Start with a beginner class and breathe steadily through every move.
Not as far as the evidence shows. Small studies found stronger breathing muscles after Pilates, but lung function didn't change consistently, and in larger reviews exercise and breathing exercises made little or no reliable difference to lung function in asthma. Pilates can help you feel fitter and breathe more steadily during effort.
Breathe in through your nose if you can and out through slightly pursed lips, breathing out on the effort, and never hold your breath. If counting 5 in and 5 out in the hundred leaves you short of breath, breathe at your own pace. If you feel dizzy or tingly, make the breaths smaller or go back to normal breathing.
No. Asthma breathing programmes, such as those physiotherapists teach, Buteyko and the Papworth method, use slow, low, relaxed breathing and improved quality of life a little in trials. Pilates breathing uses fuller breaths into the ribs, timed to movement. Neither improves lung function or prevents attacks, so neither replaces your inhalers.
Only if your asthma action plan says to. If you need your reliever before most sessions, or symptoms break through anyway, ask your GP or asthma nurse for a review. Always keep it with you.
Pilates classes usually start gently, and in our reading a gentle mat class is unlikely to bring on symptoms, though no study has tested this. Before a harder class, such as fast reformer or jumpboard work, or any session that has brought on symptoms, use a warm-up with short hard bursts: our asthma warm-up follows those trials.
No study has tested it, and Asthma + Lung UK says hot and humid air can make asthma symptoms worse. If heat is one of your triggers, choose a class at normal room temperature.
Stop, sit up straight and use your reliever as your action plan says. In an attack, take 1 puff of a blue reliever every 30 to 60 seconds up to 10 puffs (with an AIR or MART inhaler, 1 puff every 1 to 3 minutes up to 6). Call 999 if you feel worse at any time, don't feel better after the maximum dose, or don't have your inhaler.
It's a popular story, but the history sources we checked, from the Pilates Method Alliance and a profile drawing on his biographies, don't mention it; one describes him only as a weakling child. Either way, his story wouldn't show that Pilates treats asthma.
Yes, with the same rules: your reliever beside the machine, steady breathing, and a proper warm-up before fast or hard classes. Reformer classes can be harder work than a beginner mat class, so start at a beginner level.
Yes, if their asthma is controlled, with their reliever nearby. One small Brazilian study in children aged 7 to 13 found stronger breathing muscles after 12 weeks of Pilates, but it hasn't been published in a journal. Our Pilates for kids guide covers the rest.
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.
