Pilates guide
Pilates is a low-impact exercise method built on strength, trunk control, flexibility, posture and breathing, done on a mat or on spring equipment. Its strongest evidence is for long-lasting low back pain, where it helps more than doing little. It also improves trunk endurance and, in older adults, balance.
Most other benefits, from sleep to blood sugar, come from small trials, and some popular claims, such as stronger bones, longer muscles or a sharper memory, haven't held up. It is mostly light exercise: it counts toward your two weekly strength sessions, not your 150 minutes of brisk activity.
This guide grades each benefit, with the numbers and how sure the research is, then gives the moves and workouts behind the evidence and who should modify what. If you have a health condition, have had recent surgery or are pregnant, check with a doctor or physiotherapist first.
For long-lasting low back pain, Pilates reduces pain and disability more than doing little, in a Cochrane review of 10 trials, and it ranks at or near the top in network meta-analyses, which compare many exercise types at once. It is not clearly better than other exercise.
In healthy adults, Pilates added about 10 curl-ups a minute after 5 to 12 weeks, against no exercise. It built strength no better than other exercise, and reviews in older adults disagree on whether it builds strength at all.
Balance improves in older adults, at low to moderate certainty. The newest review, of 39 studies, found no drop in the number of falls.
Most Pilates is light intensity, about like a slow walk. The NHS counts it toward your 2 weekly strength days, not toward the 150 minutes of aerobic activity.
Trials found no gain in bone density, the posture results are mixed, and no exercise can lengthen a muscle. Claims about memory and immunity rest on a handful of studies of test scores and blood or saliva markers.
An overview of 27 meta-analyses of Pilates rated 25 of them low or critically low quality. Most of the trials behind them are small and short, and compare Pilates with doing nothing.
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A systematic review of 119 papers defined Pilates as a mind-body exercise focused on strength, core stability, flexibility, muscle control, posture and breathing, done on a mat or on specialised equipment. The NHS describes it as suitable for people of all ages and fitness levels.
Trials define it by its exercises: apart from breathing, the traditional principles didn't feature in the back pain trials.
Effort is measured in METs (metabolic equivalents): 1 MET is the energy you use sitting still, light activity is under 3 and moderate activity is 3 to 6. The 2024 Compendium of Physical Activities, the standard table of activity costs, lists traditional mat Pilates at 1.8 METs and general Pilates at 2.8.
Measured sessions come out a little higher, around the border of light and moderate. A 2026 review of 6 studies put a typical session at about 3 METs, or 2.9 calories (kcal) a minute, as its most reliable estimate, and in a trial of 31 young adults a 45-minute mat session matched walking at about 2 mph (3.2 km/h).
In a study of 15 young women for the American Council on Exercise (ACE), a 50-minute beginner mat routine reached 54% of maximum heart rate and burned about 175 calories, like walking at about 2 mph. An advanced routine reached 62% and about 254 calories, like walking at 3.5 to 4 mph.
The women rated both as moderately hard or harder, and the researchers concluded that the muscular effort makes Pilates feel harder than its oxygen use shows.
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Most trials ran 2 to 3 sessions a week, usually of about an hour, for 6 to 12 weeks. The benefits below come from programmes like these, not from an occasional class.
Every benefit on this page is graded strong, emerging or mixed. Most rest on small trials.
An overview of 27 meta-analyses of Pilates rated 1 high quality, 1 moderate and 25 low or critically low. Pooled across them, Pilates reduced pain and disability, improved sleep and balance, and lowered body mass index (BMI) and body fat, at very low to moderate certainty.
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Most trials compare Pilates with no exercise or minimal care. Against other exercise it is rarely better: the Cochrane back pain review found no conclusive evidence that it beats other exercise, 11 trials found no difference in strength, and none of the 11 weight-loss trials in one review compared it with other exercise at all.
Only 2 of the 10 trials in the Cochrane back pain review reported side effects, which were minor or absent. Knee osteoarthritis trials reported none but monitored little, and Australia's Pilates association says no injury statistics specific to Pilates are collected there.
Our Pilates for back pain guide has the detail, including sciatica, which moves to start with and the warning signs.
A Cochrane review of 10 trials (510 adults) found Pilates reduced pain by about 14 points on a 100-point scale in the short term, and by about 11 points at 3 to 12 months, compared with minimal care. Three network meta-analyses, of 89, 217 and 118 trials, rank Pilates at or near the top of exercise types for pain and disability, and a 2024 review of 36 studies found it beat no exercise.
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.
Against other exercise, the Cochrane review found no clear difference in disability and no conclusive evidence that Pilates is superior. A review of 11 trials found low-certainty evidence favouring Pilates over general exercise, but no strong evidence for one type of exercise over another. A review written for a World Health Organization (WHO) guideline found that exercise of any kind probably eases back pain.
In a trial of 296 adults with long-lasting back pain, Pilates once, twice or three times a week for 6 weeks all helped more than an advice booklet. Twice beat once; three times was not clearly better than twice, though it was the most cost-effective.
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Across 8 trials (439 people), Pilates eased long-lasting neck pain by about 1.5 points on a 10-point scale more than no treatment, at very low certainty. Other exercise eased pain slightly more straight after treatment, a smaller review found Pilates no better than other treatments at 3 months, and a network meta-analysis of 40 trials found the yoga, Pilates and tai chi group about as effective as strengthening or motor control exercise.
Across 9 trials in healthy people, Pilates 2 to 3 times a week for 5 to 12 weeks improved abdominal endurance against no exercise: on average about 10 more curl-ups in a one-minute test. A 12-week trial also found better upper-body endurance and hamstring flexibility, and in adults with overweight, Pilates improved abdominal and back endurance more than walking did.
A review of 39 studies in older adults found a moderate gain in strength against no exercise. A 2024 review of 24 trials (1,190 older adults) found no clear gain against no exercise and no difference from other exercise. Across 11 trials of all ages, Pilates built strength no better than other exercise.
Most mat Pilates adds little load as you get stronger, so early strength gains level off, while reformer springs give more resistance (an expert's view, quoted by National Geographic). In one trial, reformer Pilates improved grip strength in women with overweight. For bigger strength gains, add load over time: heavier springs, bands or weights.
In adult women (12 studies, about 540 women), Pilates improved the sit-and-reach test against no exercise, and older adults gained too, at low certainty. In healthy adults the gain was not statistically clear, and Pilates did no better than other exercise that moves the joints through their range.
In 12 trials (569 people), Pilates raised aerobic fitness (VO2max, the most oxygen your body can use) against no exercise, at very low to low certainty, but only after about 1,440 minutes in total: roughly twice a week for 3 months. Gains were larger in people who started less fit, and Pilates did no better than other exercise.
Three reviews, the largest of 39 studies (1,770 people), found Pilates improved balance in older adults against no exercise, at very low to moderate certainty, and about as much as other exercise. In a trial of 55 adults aged 65 to 95 at risk of falls, a reformer class once a week for 10 weeks improved balance and walking speed.
One review found a large effect on fall-risk scores. But none has shown fewer actual falls: the 2024 review of 39 studies found no reduction in the number of falls or in fear of falling, and another review, which did find less fear of falling, found no high-quality evidence that Pilates prevents falls. Better balance is not the same as fewer falls.
The WHO says balance and functional exercise reduces the rate of falls (high-certainty evidence) and asks adults over 65 to do varied balance and strength work on 3 or more days a week. A UK consensus on osteoporosis recommends balance and strength exercise, including tai chi, dance, yoga and Pilates, at least twice a week to reduce the risk of falls.
In healthy adults, a 12-week trial found no change in posture. Nine small studies in people with scoliosis or a rounded upper back reported improvements, but their quality was moderate to low. The osteoporosis consensus says yoga and Pilates programmes should be considered to help with posture and pain.
Three trials in women after the menopause found no significant change in bone density at the spine or hip, and a review of 11 studies of Pilates or yoga (591 women aged 45 to 78) found no clear effect against no exercise. A 2026 network meta-analysis grouped Pilates with yoga and tai chi and found some benefit at parts of the hip, with the best results at the spine and femoral neck (the top of the thigh bone) when combined with resistance training, but it did not test Pilates on its own.
For bone, the UK consensus recommends resistance and impact exercise. Pilates fits in as balance and strength work, with precautions on rounding the spine. Our exercise for osteoporosis guide and bone-strengthening workout cover the rest.
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Small trials found large drops in depression and anxiety symptoms, mostly against no exercise, including 18 trials in women. But the largest review, of 32 trials (1,264 people), found clear gains only for quality of life and self-esteem: results for depression and anxiety were limited or not significant. Once-weekly programmes also showed benefits.
The largest network meta-analysis of exercise for depression (218 trials, 14,170 people) found walking or jogging, yoga and strength training among the most effective. It included no Pilates trials, so Pilates is untested at that scale rather than ruled out.
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In 6 trials (477 people), Pilates improved sleep quality scores against no exercise, though results varied widely and there was no clear effect in healthy over-40s or in women after the menopause. Two network meta-analyses ranked Pilates first among exercise types, but one drew on only 5 Pilates trials and found no significant difference between types, and in older adults Pilates was not among the best options.
In women after the menopause (11 trials), Pilates improved 5 of 9 areas of a quality-of-life questionnaire, including bodily pain and physical functioning, more so with equipment and 48 or more sessions, at very low to moderate certainty. Across chronic conditions (18 trials), it improved physical function but not fatigue or overall quality of life.
In people with high blood pressure (4 randomised trials and 7 other comparative studies), Pilates lowered blood pressure by about 5/3 mmHg (systolic over diastolic) more than comparison groups. The authors note it may not beat other forms of exercise.
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In people with type 2 diabetes, Pilates lowered HbA1c (average blood sugar over the past 2 to 3 months) by about 0.8 to 1 percentage point against no exercise or usual care, in small trials with varied results. It made no clear difference to blood sugar in people without diabetes, and in a network meta-analysis all mind-body exercise, yoga included, helped.
Across 11 small trials in adults with overweight or obesity, mostly women, Pilates took off about 2.4 kg more than doing nothing, and only in programmes longer than 10 weeks. In healthy-weight adults, mat Pilates changed body composition no more than control or other exercise, and in women it lowered BMI but not body fat or waist size. Our Pilates for weight loss guide has the detail.
In healthy women, Pilates didn't change pelvic floor muscle function. A Cochrane review found that training with deliberate pelvic floor squeezes may improve quality of life more than exercise without them (low certainty), and in a small trial of older women with leaking, yoga eased symptoms more than Pilates.
Pilates moves put no more pressure on the pelvic floor than standing up from a chair, apart from roll-ups, so in our view it is fine alongside pelvic floor exercises.
Trials were small and often unblinded, and Pilates was rarely better than other exercise. If you have one of these conditions, ask your care team which class suits you.
In a network meta-analysis of 22 trials (901 people), Pilates ranked first for mobility and balance against control groups, though no comparison reached high certainty. An earlier review found its benefits no greater than those of other physiotherapy.
Across 6 trials (265 people), Pilates eased pain by about 0.7 points on a 10-point scale and reduced the condition's impact on daily life. In a network meta-analysis of 59 trials in women, Pilates, water exercise and strength training ranked highest in the short term.
Across 6 trials (531 women), Pilates eased pain; fatigue and sleep didn't improve significantly. An earlier review found it no better than other exercise for shoulder movement or quality of life, apart from pain and arm function.
Pilates eased knee pain against no exercise (11 studies, low certainty) but not more than conventional exercise, and negative studies may be missing. A network meta-analysis of mind-body exercise ranked Pilates and tai chi best for pain and function.
In 4 randomised and 4 non-randomised studies, Pilates improved leg function more than conventional training.
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Three small trials of 30 to 40 women each found fewer menopausal symptoms with Pilates, including when it was taught online. Against aerobic exercise, both improved mood, sleep and quality of life, with an extra short-term benefit for symptoms from Pilates. There is no review yet.
In trials, women including those past the menopause gained back pain relief, quality of life and balance, and small trials found fewer menopausal symptoms. Sleep scores didn't clearly improve in the trials of women after the menopause.
Pilates didn't change bone density in trials, so add heavier strength training and impact work for bone, as the UK osteoporosis consensus recommends. With osteoporosis, swap deep curl-ups and roll-downs for flat-back or head-down versions.
Adults over 65 are advised to do strength, balance and flexibility work on at least 2 days a week, and Pilates counts. Our Pilates for seniors guide covers chair Pilates, joint replacements and choosing a class.
UK and WHO guidelines advise muscle-strengthening activity on at least 2 days a week, and the NHS lists Pilates as one. The UK Chief Medical Officers (CMO) add that any strengthening activity is better than none, with benefits seen from just over 30 and up to 120 minutes a week.
Pilates doesn't replace aerobic activity: aim for 150 minutes of moderate activity a week as well, such as brisk walking. The CMO guidelines, updated in July 2026, add that the health benefits of light activity, which is where most Pilates sits, can match those of moderate activity if you do it for longer.
Most trials used 2 to 3 sessions a week for 6 to 12 weeks. Once a week still helped in some trials, for back pain, for balance in older adults and for well-being, and twice beat once for back pain. Our editorial starting point, the same as on our main Pilates guide: 2 to 3 sessions a week of 20 to 45 minutes.
In trials, back pain improved within 6 weeks, trunk endurance within 5 to 12 weeks, flexibility over 8 to 12 weeks, and aerobic fitness after about 3 months of twice-weekly practice. Weight changed only in programmes longer than 10 weeks. Before-and-after photos mostly show body fat and posture on the day, not longer muscles (our view).
Our editorial starting point: once a move feels easy for the full dose, step up to its harder version, or add a band, light weights or a heavier reformer spring. For bone, add impact and heavier resistance work, as in our bone-strengthening workout.
Start with the breath, then pick one or two from each group in this order: trunk endurance, back extension, hips, mobility and standing balance (doses are on each move's page).
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoHundred (Pilates)Intermediate · No equipment
3D demoChest lift (Pilates curl-up)Beginner · No equipment
3D demoDead bug heel tapsBeginner · No equipment
3D demoSingle-leg stretch (Pilates one leg stretch)Intermediate · No equipment
3D demoKnee hover (Pilates tabletop hover)Beginner · No equipment
3D demoStraight-arm plank (high plank)Intermediate · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoBird dogBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoShoulder bridge (Pilates)Intermediate · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSpine stretch forward (Pilates spine stretch)Beginner · No equipment
3D demoSaw (Pilates)Intermediate · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoSingle-leg standBeginner · A wallStart with the beginner workout. The balance and bone workouts add what Pilates on its own doesn't.
A 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 30-minute intermediate mat Pilates class that follows the classical order, from the hundred to the push-up, with prep versions of the hardest moves.
30 minIntermediate22 movesNo equipmentTen minutes of the classic Pilates abdominal series: the hundred, the roll-up and the series of five, with a plank to finish.
10 minIntermediate11 movesNo equipmentA gentle 15-minute Pilates-based routine for ongoing low back pain, built from neutral-spine moves with options for backs that dislike bending or arching.
15 minBeginner10 movesNo equipmentA 20-minute beginner wall Pilates workout: standing and floor moves that use a wall for support and feedback. No equipment.
20 minBeginner9 movesA wallBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsTwo mat days and one wall day a week, with walking days for the aerobic minutes.
A UK consensus advises avoiding sustained, repeated or end-range rounding of the spine, especially under load, and suggests alternatives to Pilates roll-downs and curl-ups as a precaution; people who already move comfortably and smoothly can continue. Keep the back-extension moves, and after a spinal fracture choose a teacher who knows how to work with it.
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Skip moves that roll your weight toward your neck, such as the roll-over and jack knife, and use the head-down version of every curl-up.
Later in pregnancy, avoid lying flat on your back for more than a few minutes and avoid activities with a risk of falling, and ask your midwife before starting something new. Our Pilates in pregnancy guide shows which moves to swap.
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Do pelvic floor exercises with deliberate squeezes first, with Pilates alongside rather than instead, and see a GP or pelvic health physiotherapist.
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If you have a condition such as MS, fibromyalgia, arthritis or cancer, ask your care team which class or programme suits you, and keep to the treatments you've been prescribed. If you take insulin or a sulfonylurea for diabetes, exercise can bring on a hypo: our type 2 diabetes guide explains what to do.
For chest pain that feels tight or like squeezing, or spreads to your arms, neck or jaw; severe difficulty breathing, such as gasping, choking or not being able to get words out; lips or skin that turn pale, blue or grey; or if someone has passed out and isn't responding normally.
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If you have pain, tingling, weakness or numbness in both legs, loss of feeling around your genitals or anus, changes in your bladder or bowels or in how sex feels, or back pain that started after a serious accident.
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If you're suddenly more short of breath than usual, have chest pain with feeling sick or a racing, slow or fluttering heartbeat, or have back pain and feel hot, shivery or generally unwell, or severe back pain that starts suddenly or is getting worse quickly. In the US, contact your doctor or urgent care.
Before starting, if you have a health problem, an injury or symptoms, or you're pregnant or have recently given birth. Later, if back pain isn't improving after a few weeks, stops you doing daily activities, is worse at night, or comes with unexplained weight loss.
Stop for sharp or increasing pain, pain or tingling that travels down an arm or leg, dizziness, or neck strain in the curl-ups (rest your head).
Exercise can't change where a muscle attaches to its tendons, so it can't make a muscle longer, and there's no such thing as a long, lean muscle versus a bulky one. A leaner look comes from less body fat.
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Trials in women after the menopause found no significant change in bone density, alone or pooled with yoga. For bone, add resistance and impact exercise.
It improves balance, but the 2024 review of 39 studies found no reduction in the number of falls.
A 12-week trial in healthy adults found no change in posture; small studies in people with scoliosis or a rounded upper back were more positive.
It is light intensity, 1.8 to 2.8 METs in the Compendium, and the NHS lists it as muscle-strengthening, not aerobic activity. Unfit beginners can still gain some aerobic fitness over months.
It didn't change pelvic floor muscle function in healthy women, and training with deliberate squeezes works better than exercise without them.
Small trials found better scores on some thinking tests, such as verbal fluency, but none has looked at cognitive decline or dementia.
The evidence is changes in saliva and blood markers in two studies, one of just 12 older women, and in the other aerobic exercise had the bigger effect. No study has counted infections.
No study shows it. Better posture can change how tall you stand, and even the posture evidence is mixed.
Its best evidence is for long-lasting low back pain, where it helps more than doing little, and for trunk endurance. It also improves balance in older adults and flexibility, and small trials suggest better sleep and quality of life. It is light exercise, so it doesn't replace brisk aerobic activity.
The NHS counts it as muscle-strengthening activity for the twice-weekly guideline. In trials it built strength about as well as other exercise types, though a 2024 review found no clear gain in older adults. For bigger strength gains, add load over time: heavier reformer springs, bands or weights.
Not much. The 2024 Compendium of Physical Activities rates it at 1.8 to 2.8 METs, which is light, and a typical session is about like a slow walk. People who start unfit can raise their aerobic fitness over about 3 months, but you still need brisk walking, cycling or similar.
In trials, Pilates helped back pain, balance and quality of life after the menopause, and small trials found fewer menopausal symptoms. It did not change bone density, so pair it with strength training and impact work for bone. With osteoporosis, swap the deep curl-ups and roll-downs for flat-back or head-down versions.
Not on its own: trials in women after the menopause found no significant change. A UK consensus still recommends Pilates for people with osteoporosis as balance and strength exercise, to help reduce the risk of falls, with precautions on rounding the spine.
Not reliably. A 12-week trial in healthy adults found no change, while small studies in people with scoliosis or a rounded upper back reported improvements.
Probably: sit-and-reach scores improved in women and older adults against no exercise. It did no better than other exercise that moves the joints through their range.
Possibly. Small trials found large improvements in mood and sleep, but the newest review of 32 trials found clear gains only for quality of life and self-esteem. For depression, walking or jogging, yoga and strength training have the strongest evidence.
Once a week still helped in trials, including for back pain and for balance in older adults. In a back pain trial, twice a week did better than once, so two or three sessions is a better target if you can manage it.
Trials found trunk endurance gains in 5 to 12 weeks, back pain improving within 6 weeks, and aerobic fitness after about 3 months of twice-weekly practice. Weight changed only in programmes longer than 10 weeks.
Not as well as pelvic floor exercises themselves. A Cochrane review found training with deliberate pelvic floor squeezes worked better than exercise without them, so do the squeezes as well.
No study shows it. Better posture can change how tall you stand, but even the posture evidence is mixed.
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.
