Pilates for balance: what it can do, the moves that help and staying safe

Balance tests improve

Across reviews of up to 39 studies, Pilates improved balance tests in older adults against no exercise, most clearly balance on the move, at very low to moderate certainty.

Sources 1, 2, 3

About as much as other exercise

In a network analysis of 423 trials, almost every kind of exercise improved balance, and the authors say their estimates don't show that any one type is better. Head to head, Pilates sometimes matched other training and sometimes did worse.

Sources 4, 1, 5

Fewer falls: not shown

The one trial that counted falls found fewer fall injuries with Pilates, but the difference could have been chance, and a review of 39 studies found no fall in the number of falls.

Sources 6, 1

It may ease fear of falling

Supervised group classes such as Pilates or yoga had among the largest effects on worry about falling.

Sources 7, 8

Make it challenge your balance

In trials, most Pilates exercises gave little challenge to balance. Add standing work with a narrower stance, one leg, stepping and reaching, 3 times a week if you can, and keep it up for at least 12 weeks.

Sources 3, 7, 9

Know when to get help

Call 999 for signs of a stroke, even if they pass, and see a GP if you've had a fall or you're worried about your balance.

Sources 10, 11

Balance has several parts

Researchers split balance into holding still (static balance, such as standing on one leg), staying steady while you move (dynamic balance, such as walking and turning), steadying yourself before a movement you plan, such as reaching (proactive balance), and catching yourself after a trip or a push (reactive balance). Different kinds of exercise train different parts.

Sources 4, 12

Why it matters

About 842,000 people died from falls worldwide in 2023, 71% of them aged 60 or over. The NHS lists causes of falls including weaker muscles, conditions such as arthritis, stroke or Parkinson's, low blood pressure, some medicines, eyesight or hearing problems and dementia.

Sources 13, 11

What Pilates adds, and what it often lacks

Pilates trains control of the trunk and hips, single-leg and side-lying work, and slow movement with attention. What it often lacks is challenge: in the trials reviewed in 2015, only 2% to 36% of the exercises gave a moderate or high challenge to balance. The world falls guidelines ask for exercise that challenges balance, such as standing with a narrower base, reaching while standing, and stepping and walking in different directions, plus everyday moves such as sit-to-stands, made harder over time.

Sources 3, 7

Balance is a skill and a strength

The UK guidelines name "standing on one leg, backwards walking, activities that involve 3-dimensional movement" as balance activities, alongside strength work. The NHS balance exercises are sideways walking, grapevine steps, heel-to-toe walking, one-leg stands and step-ups, and its strength exercises include slow sit-to-stands, calf raises and sideways leg lifts.

Sources 14, 9, 15

Balance tests improve in older adultsEmerging evidence

In the largest review (39 studies, 1,770 people, only 14 of good quality), Pilates beat no exercise for balance on the move (standardised mean differences of 0.72 to 1.60) more than for standing still (0.25 to 0.37), at very low to moderate certainty. Another review of 39 trials found a smaller overall effect on balance (0.36, low certainty). Earlier reviews of 6 to 15 trials agree on the direction, and warn that weak trials may overstate it.

Sources 1, 2, 3, 16, 17, 18, 19, 20

About as much as other exerciseEmerging evidence

In a network analysis of 423 trials in 33,901 people aged 60 or over, read as an abstract, 18 of 19 kinds of exercise improved balance; stretching didn't. Pilates was near the top for balance on the move, as tai chi, perturbation training (practising recovering from slips and trips) and agility stepping were for other parts of balance, but the authors say "these estimates do not establish superiority". A smaller network analysis rated its Pilates evidence very low certainty, and the largest Pilates review found Pilates "comparable to other forms of exercise".

Sources 4, 21, 1

Typical trialsEmerging evidence

A reformer class once a week for 10 weeks improved balance and walking speed in 55 adults aged 65 to 95 at risk of falls. Twelve weeks of mat Pilates improved standing balance and balance confidence in 110 women aged about 69. Six weeks of Pilates added to physiotherapy helped women over 65 with back pain stand up, walk and turn faster.

Sources 22, 23, 24

Younger, fit adults: mixedMixed evidence

In healthy adults, one trial found better standing balance after 8 weeks of Pilates and another found no change after 12. In footballers with unstable ankles, balance training improved a reach test more than Pilates did, while Pilates improved a hopping test more.

Sources 25, 26, 27

Head to head: mixed resultsMixed evidence

Pilates matched traditional balance and strength training in 31 people at risk of falls, and only the Pilates group grew more confident about their balance. It beat a general activity programme and matched a programme of PNF (proprioceptive neuromuscular facilitation) exercises. But Zumba, sensorimotor and water training, aerobic exercise for the same total time, and core training each did better than Pilates in single small trials.

Sources 28, 29, 30, 31, 32, 5, 33

Tai chi: no head-to-head trialMixed evidence

We found no trial comparing Pilates with tai chi. Tai chi has falls trials and a strong recommendation in the world falls guidelines; Pilates has neither yet.

Sources 34, 7

Yoga: two tiny trialsEmerging evidence

Only two small trials have compared Pilates and yoga for balance, both in younger adults: 20 elite female fencers and 24 stressed adults aged 30 to 39. In both, Pilates and yoga improved balance tests about equally over 8 weeks. Neither was in older adults or counted falls; our yoga for balance guide covers yoga.

Sources 35, 36

Choose what you'll keep doing

Balance improves with regular practice that challenges it, whatever the kind. Pilates is one good way to do that, especially for balance on the move, as long as you add standing work.

Sources 7, 37

Fewer falls: not shownMixed evidence

The only randomised trial that counted falls (53 people aged 61 to 84; a 60-minute class twice a week for 12 weeks) found 42% fewer fall injuries and 64% fewer injurious falls over 24 weeks, but neither difference was statistically significant, and the authors worked out that a definitive trial would need 804 people. A review of 39 studies found no reduction in the number of falls.

Sources 6, 1, 3

Fear of falling may easeEmerging evidence

Across 62 trials, holistic exercise such as Pilates or yoga was linked with a bigger drop in fear of falling, and the world falls guidelines say supervised holistic classes in the community, "such as Pilates or yoga", had the largest effects on concerns about falling. One review found no effect.

Sources 8, 38, 7, 1

What does prevent fallsStrong evidence

Exercise cut the rate of falls by about 23% in older people living at home (high certainty), mainly balance and functional exercise. The world falls guidelines recommend exercise that challenges balance, such as sit-to-stands and stepping, 3 or more times a week, made harder over at least 12 weeks, with tai chi or progressive strength training where possible, and say that walking alone is unlikely to prevent falls. The National Institute for Health and Care Excellence (NICE) wants falls programmes led by trained professionals, made harder over time and tailored to you, focused on balance, coordination, strength and power.

Sources 37, 7, 39

After a strokeEmerging evidence

Across 5 small trials (122 people), Pilates improved balance, with moderate evidence. Our guide to exercise after a stroke covers the rest.

Source 40

Multiple sclerosis (MS)Emerging evidence

Across 22 trials (901 people), Pilates improved balance and the timed up and go test (standing up, walking 3 metres, turning and sitting down), though no comparison reached high certainty. Our Pilates for MS guide has more.

Sources 41, 42

Parkinson'sEmerging evidence

In 8 small studies of poor to fair quality, Pilates helped balance, and in one trial of 40 people, clinical Pilates improved balance on the move more than standard physiotherapy. Ask your team which exercises suit you; our exercise for Parkinson's guide covers the rest.

Sources 43, 12, 44

Dizzy when you stand, or low blood pressure

Get up slowly from lying and sitting, and keep head-down moves such as the roll-down brief: the NHS advises getting up slowly from sitting to standing if you have low blood pressure.

Source 45

With osteoporosis

Skip rolling like a ball, the teaser and control balance, which round your spine under load. The standing work and side-lying moves suit you, and the UK consensus recommends balance and strength work at least twice a week.

Source 46

Numb feet or glaucoma

With numb feet, keep a hand on the counter for all standing balance work; with glaucoma, keep head-down positions brief (each move's own caution).

Eyes closed, foam and cushions

Leave these out unless a physiotherapist sets them: the falls guidelines ask for balance work that is challenging but also safe and achievable.

Source 7

What the trials used

Most Pilates balance trials used 2 or 3 classes a week of 50 to 60 minutes for 8 to 12 weeks. One reformer class a week for 10 weeks still helped, and a review found no clear link between how much people did and how much their balance improved.

Sources 6, 28, 23, 22, 16

What the falls guidelines ask

Exercise that challenges balance 3 or more times a week, made harder over at least 12 weeks and kept up. The NHS asks older adults for strength, balance and flexibility work on at least 2 days a week, and suggests its balance exercises at least twice a week. In a review of 10 trials that included Pilates, programmes done more often and for longer cut fall risk most.

Sources 7, 47, 9, 48

Our suggested week

Our 25-minute standing Pilates class 2 or 3 times a week, a few minutes of balance practice by the counter on other days, and a strength session if you can, for at least 12 weeks (our editorial starting point).

Source 7

Call 999

In the US, call 911.

• Signs of a stroke: a face drooping on one side, weakness in an arm, or slurred or confused speech. Call even if the signs go away; feeling dizzy or falling over can also be a sign.
• After a fall, if someone may have injured their head, back, neck or hip, or can't get up.
• If someone faints while exercising, can't be woken within a minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 10, 11, 49

Call 111

If you've fallen and may be in pain, hurt or unwell; or you've hit your head and you take medicine that thins your blood (or have a condition that does), or you're being sick or feel dizzy. NICE says people who take blood thinners, other than aspirin alone, and hit their head should be sent to an emergency department. Don't drive yourself to A&E after a head injury.

Sources 11, 50, 51

See a GP

If you've had a fall or you're worried about your balance (you may be able to refer yourself to a falls service), if you've fainted, if dizziness worries you, or if you keep feeling dizzy or faint when you stand up. NICE offers a full falls assessment to people who have fallen in the last year and are frail, were hurt, blacked out, couldn't get up, or have fallen twice or more.

Sources 11, 49, 52, 45, 39

A spinning feeling

Vertigo, the feeling that you or the room is spinning, needs a different kind of balance exercise; our vertigo guide covers it, and a GP can check the cause.

While you practise

Keep a counter or wall in reach and the floor clear, stop if you feel dizzy, faint or unwell, and stand up slowly from the mat (our suggestion).

Source 45

"Pilates prevents falls"Mixed evidence

It hasn't been shown to. The one trial that counted falls found fewer fall injuries, but the difference could have been chance, and a review of 39 studies found no fall in the number of falls.

Sources 6, 1

"Pilates is the best exercise for balance"Mixed evidence

Almost every kind of exercise improved balance across 423 trials, and the authors say their rankings don't show any type is better. Aerobic exercise, sensorimotor training and Zumba each beat Pilates in single trials.

Sources 4, 5, 32, 31

"Walking is enough to keep you steady"Strong evidence

The world falls guidelines say "General physical activity alone (e.g. walking) is unlikely to prevent falls", and ask for exercise that challenges balance and builds strength.

Source 7

"A strong core is all you need for balance"Mixed evidence

Core training improved balance tests in older adults, but the falls guidelines want standing, everyday practice such as sit-to-stands, stepping and reaching, and most Pilates programmes rarely challenged balance.

Sources 33, 7, 3

"Balance just gets worse with age"Emerging evidence

Balance improved with almost every kind of exercise in 423 trials of people aged 60 or over.

Source 4

"After a fall, it's safer to do less"Strong evidence

NICE offers falls prevention exercise to people who have fallen, and the NHS advises staying active, with strength and balance activities at least twice a week.

Sources 39, 11