Pilates guide
Pilates can be an enjoyable way for children and adults with cerebral palsy (CP) to practise trunk control, balance and breathing. It doesn't treat CP, and it doesn't replace physiotherapy or any therapy your team gives. The trials are small: in the best-designed one, 46 children who walk had no change in walking and only a small balance gain after 4 weeks of classes, while smaller trials that added Pilates on top of physiotherapy found more.
So this guide pairs Pilates with what has the best evidence: strength training, everyday activity and sport. It's for children, their parents and carers, and adults with CP, whether you walk on your own, use a walking aid or use a wheelchair.
It covers what the evidence shows, moves lying down, sitting and standing with a chair, honest information on stretching and spasticity, hips, seizures and adapting for different levels, and when to get help, with a free 25-minute class. Your physiotherapist and CP team come first.
The NHS: "There's currently no cure for cerebral palsy, but treatments are available to help people with the condition be as active and independent as possible", and physiotherapy is "one of the most important treatments for cerebral palsy". Pilates sits beside physiotherapy, strength training, sport and your team's plan, never instead.
Four randomised trials in children who walk, with 18 to 81 children each. The best-designed found no change in walking and a balance gain too small to matter. The positive ones were small and single-centre, and gave extra exercise time, had no untrained group, or compared Pilates with a therapy rated ineffective.
A 2025 review of mind-body exercise in children found better balance but no change in walking; we couldn't confirm exactly which studies it pooled, though its reference list holds the Pilates trials. No trial has followed children after the classes ended.
In 17 adults who chose Pilates or their usual activities, balance tests improved more with Pilates; it wasn't randomised. In adults, exercise reliably builds leg strength, and every kind studied appears safe.
Strength and fitness training are rated effective for children with CP, and strength training doesn't make spasticity worse. Our reading: Pilates fits best as trunk control and balance practice beside strength work, not instead of it.
About 1 in 3 children with CP develop hips that move out of place, so a child's hip pain or a change in sitting, standing or walking goes to the team. On its own, stretching changes how far a joint moves by about 2 degrees: stretch for comfort, never forced.
The NHS: "Cerebral palsy is the name for a group of lifelong conditions that affect movement and co-ordination." The original brain problem doesn't get worse, though the NHS says the condition can put strain on the body and cause problems such as painful joints in later life, and NHS inform adds: "Symptoms can change with age, even in adulthood."
Scope, the UK charity, says it affects about one in every 400 children in the UK. The Cerebral Palsy Alliance calls it "the most common physical disability in childhood".
The NHS names spastic, dyskinetic, ataxic and mixed types; in spastic CP, "the muscles are stiff and tight (especially when trying to move them quickly)", and about 85% of children have spasticity as their main type. Movement is described with the Gross Motor Function Classification System (GMFCS), from level I to level V; NICE describes levels IV and V as not walking (non-ambulant). The Pilates trials included only children who walk, at levels I and II, with one small trial up to level III.
The NHS lists seizures (epilepsy), a learning disability (about half of children with CP), eye and hearing problems, feeding and swallowing problems, scoliosis, and "hips that pop out (dislocate) easily". Scope says epilepsy affects up to a third of children with CP. Children who don't walk have an increased risk of fractures from minor knocks, NICE says.
NICE says some people "use their spasticity or dystonia to help their posture and ability to stand, walk or transfer". So relaxing tight muscles isn't always the aim: steadiness, trunk control and strength usually matter more (our reading).
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The trials used mat work (the hundred with the head down, bridges, leg circles, toe taps, leg work on all fours), sitting on a ball, standing work with a ball or a wall, and heel-to-toe walking, often in small groups led by physiotherapists with balls, wobble boards and mirrors. Typical classes also roll, fold deeply, balance on one leg for a long time and get up and down from the floor; with CP these need a wall, a chair, a helper, shorter blocks and a teacher who adapts rather than pushes (our reading).
Four small Pilates trials in children who walk, one small study in adults, and better evidence for strength training.
In an Irish trial at two sites, 46 children aged 7 to 17 with spastic CP who walk (GMFCS levels I and II) did Pilates-based group classes (60 minutes, twice a week for 4 weeks) or their usual exercise. Walking didn't change, and balance improved by about 1.4 points on a 56-point scale, less than the 3 points that matter. The authors: "Pilates-based exercises did not change lower limb or trunk kinematics during walking in children with CP and had a clinically insignificant impact on balance." Children went to a median of 5 of 8 classes, home practice mostly didn't happen, and most who answered enjoyed it.
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In an Egyptian trial, 40 children aged 7 to 9 with spastic diplegia (CP mainly affecting the legs) had 45 minutes of physiotherapy, and half also had 45 minutes of Pilates, 3 times a week for 10 weeks. The Pilates group ended with higher balance, standing and walking scores, but the authors say "the improvement in this study could be attributed to the differences in the duration of exercise rather than the type of exercise". A published correction changed only an author's affiliation.
In 81 teenagers aged 12 to 18 with CP on one side of the body, Pilates-based core strengthening, plyometrics (jumping training) and the two combined, twice a week for 12 weeks, all improved balance and mobility, and the combination did best. There was no group without training, so the Pilates gains can't be separated from time and practice, and the trial was registered after it ran.
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In 18 children, modified Pilates twice a week for 8 weeks improved sitting balance and trunk control more than neurodevelopmental therapy, a hands-on approach the main evidence review rates as ineffective in its passive form. The summary gives no effect sizes.
A 2025 review of 6 small mind-body studies (173 children), mostly the Pilates trials above, found better balance but no difference in walking. Reviews of Pilates in children in general found the research at an early stage. Two more Pilates trials in children have finished without results being posted.
In Korea, 17 adults with CP (average age about 51) chose Pilates for 90 minutes twice a week for 12 weeks (10 people) or their usual activities (7). Balance tests improved more with Pilates. The authors call Pilates feasible; the groups chose themselves and were small.
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Across 15 trials (454 children, mostly from Egypt, Pakistan, Turkey and India, of moderate quality), trunk training improved gross motor function a little; balance gains weren't statistically clear, and "Only one study assessed spasticity and found no group difference". An older review rated trunk-targeted training among the exercise types with moderate evidence for postural control.
Across 24 trials (579 children): "Exercise is effective in improving gross motor function and balance in children with cerebral palsy", though the authors were "unable to provide definitive training recommendations". Most core trials added 30 to 45 minutes of core work to physiotherapy, 3 times a week for 8 to 12 weeks, so extra exercise time is part of the effect.
In the one randomised yoga trial (MiYoga, 42 children), attention improved but "MiYoga had no significant effect on physical functioning", and 23 of the 42 families came back at 6 months. Our yoga for cerebral palsy guide covers yoga.
Strength training is rated effective for strength in children with CP. Across 27 trials (847 children and teenagers), it also improved balance, walking speed and gross motor scores, and "All studies demonstrated that strength training did not change or have adverse effects on spasticity". A Cochrane review of 29 trials found "exercise appears to be safe for people with CP; only 55% of trials, however, reported adverse events".
None of the trials used a reformer (a single case report, in which one child gained leg strength and steadier standing after 8 weeks, may have), and none included children or adults at GMFCS levels IV or V. The evidence for them is missing, not negative.
Starting points to discuss with your physiotherapist or your child's team, for someone without warning signs.
Two or three sessions a week is a reasonable start (our suggestion); the trials ran 2 or 3 sessions a week for 4 to 12 weeks, of 45 to 60 minutes. Our class takes 25 minutes.
The exercise recommendations for people with CP advise a first few weeks of very light, simple exercise before building up, which suits a new Pilates class too.
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In the Irish trial, children enjoyed the classes but missed many, and home practice mostly didn't happen. The authors concluded Pilates-based exercise should be delivered within supervised practice: a regular class with a teacher or a parent beats an ambitious home plan.
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Strength training and fitness training carry the best evidence, and NICE asks professionals to talk with adults about physical activity for fitness and health. Pair Pilates with our cerebral palsy strength workout and with sport or everyday activity you enjoy; CP Sport supports people with CP in England and Wales to take part in sport.
A helper can guide the legs. Lateral breathing: the move page's dose, "5 to 8 breaths at the start of every session". Bridge and dead bug: up to 10, the Egyptian trial's repetitions. Leg circles: adapted from the move page's dose, up to 10 small circles each leg, the other knee bent. Hundred: the move page's dose, "50 beats to start, building to 100 (the classical count)", head down and knees bent, as in the trial. Knee fold, the easier swap for the dead bug: the move page's dose, "2 sets of 5 to 10 each side, every other day".
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoGlute bridgeBeginner · No equipment
3D demoDead bug heel tapsBeginner · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoHundred (Pilates)Intermediate · No equipment
3D demoKnee foldBeginner · No equipmentClam: up to 10 each side (our editorial starting point). Side kick: the move page's dose, "8 to 10 each side", bottom knee bent. Swan: adapted from the move page's dose, 5 small lifts, arms by your sides. Swimming: adapted from the move page's dose, 2 rounds of 10 to 20 seconds. On all fours if kneeling is comfortable: one-limb bird dog, up to 10 each side (our editorial starting point), and cat-cow: the move page's dose, "8 waves, slower than feels natural".
3D demoClamshellBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoCat-cowBeginner · No equipmentOn a firm chair, a bench or a wheelchair with the brakes on. Seated march: the move page's dose, "1 to 2 minutes as a warm-up (the Otago-based Later Life Training booklet)", the trial's leg lifts done on a chair. Thoracic rotation, the trial's twist done sitting: the move page's dose, "6 rotations per side, moving with the breath". Breath reach: the move page's dose, "5 breaths, exhale longer than inhale". Seated upper-back lift: 5 holds of 3 to 5 seconds (our seated chair Pilates class).
For people who stand, with a chair, counter or wall and a helper close by. Sit to stand: 5 to 10 (our editorial starting point). Sit squat: up to 10 shallow squats with your back near a wall, the trial's wall squat. Semi-tandem stance: 3 holds of 10 seconds each side, one hand on a counter (our cerebral palsy strength workout). Heel-to-toe walk: 2 or 3 lengths beside a wall, as the trial did (lengths editorial). Side-stepping: the move page's dose, "10 steps each way, next to a counter (the NHS balance exercises)". Wall side leg lift: the move page's dose, "10 to 12 each side".
3D demoSit to stand from a chairBeginner · A bench or box
3D demoSit squat (partial squat)Beginner · No equipment
3D demoSemi-tandem stanceBeginner · A wall
3D demoTandem stance and heel-to-toe walkBeginner · A wall
3D demoSide-stepping (sideways walking)Beginner · A wall
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wallAcross stretch trials in people with neurological conditions, stretching changed how far a joint moved by about 2 degrees (high-quality evidence). In children with CP, there was "limited evidence that manual stretching can increase range of movements, reduce spasticity, or improve walking efficiency", and passive stretching on its own is rated as appearing ineffective.
Medical treatments do: botulinum toxin injections, medicines such as baclofen, and some operations, which your team decides on. Exercise, including Pilates, isn't a treatment for spasticity.
In 16 children, calf strengthening plus stretching changed the calf muscle and tendon more than stretching alone, though ankle range improved equally. A UK trial of a tailored stretching programme in 334 children is due to report in 2027.
Stretch trials recorded skin breakdown, bruising and blisters, so never let a helper push a limb further than it goes on its own. NICE suggests building therapy into daily routines, "for example, standing at the sink while brushing teeth in order to stretch leg muscles".
In 323 children followed for nearly 12 years, hips moved out of place in 35%: none at GMFCS level I and 90% at level V. Hip checks (hip surveillance) are strongly recommended, and in Europe surveillance programmes went with fewer dislocated hips. NICE lists "pain arising from the hip" and "deterioration in sitting or standing" among the signs. With a hip under watch, ask the physiotherapist which positions suit, and leave out wide straddle stretches pushed by a helper (our suggestion).
Weak bones are more likely in people who don't walk, have a low weight or take some anti-seizure medicines, NICE says. Move smoothly, never force a stretch, and our Pilates for osteoporosis guide covers bending and twisting with weak bones.
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With epilepsy that isn't well controlled, breathing problems, a risk of food or drink going down the wrong way, or fragile bones, equipment and techniques need to be safe and appropriate: plan activity with your child's team.
Keep breathing slow and steady, with no breath-holding (our suggestion).
NICE says to provide an adapted physical therapy programme after treatments such as botulinum toxin injections, orthopaedic surgery or selective dorsal rhizotomy. Follow that programme first, and ask before adding classes (our suggestion).
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Rolling like a ball, the roll-over, the jack knife, the open-leg rocker and the teaser need control the trials didn't ask for and some put weight on the neck. Long one-leg balances without support, and wobble cushions without a helper, can wait (our suggestion).
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Keep sessions short, playful and supervised, with an adult close by. Let your child help choose the moves, show each one on the 3D figure, and fit Pilates around the programme their physiotherapist sets (our suggestion). Our Pilates for kids guide covers children's classes in general.
Walking gets harder earlier than for other people in 25% or more of adults with CP; adults with CP had 3.64 times the odds of a recorded fall in UK GP records; about 70% have pain; and fatigue is common. Across 63 studies, an active lifestyle and sports programme reduced pain while medicines and surgery didn't, on very low to low quality evidence.
In adults, exercise raised leg strength but not walking speed across 22 studies; balance training beat seated activities for confidence in walking; and "All modes of exercise reviewed appear safe for adults with CP and choice should be based on the client's preferences, access to services, and convenience". NICE's committee found little research but agreed activity helps strength, range of movement, fitness and a healthy weight.
Scope warns that "Many people with CP push themselves to their physical limit". On a tired day, do the sitting block only.
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The sitting block works on its own, and our seated chair Pilates class needs no standing. Put your brakes on if you use a wheelchair, and ask your physiotherapist about supported standing or transfers. No Pilates trial has included people who don't walk, so this is our suggestion.
Our supported class works lying, sitting and standing with a chair, built from the moves in a Pilates trial in children; its structure is our own and untested. Pair it with the cerebral palsy strength workout, which has the best evidence. The seated chair Pilates class needs no standing; the chair Pilates class adds standing with a chair; the adapted yoga class is the yoga page's; the standing Pilates for balance class suits teenagers and adults who stand with support.
A 25-minute adapted Pilates class for children and adults with cerebral palsy: lying, sitting and standing with a chair, with a seated option for each block.
25 minBeginner16 movesBench or box, wallA 25-minute home session for teenagers and adults with cerebral palsy who walk: simple strength moves first, then sit-to-stands, step-ups and balance.
25 minBeginner15 movesBench or box, something with weightA 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 movesBench 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 movesBench or box, something with weightA 25-minute adapted yoga class for cerebral palsy, for children and adults: seated poses, strength and balance at a chair, then long, easy stretches and rest.
25 minBeginner16 movesBench or box, wallA 25-minute Pilates class for steadier balance: standing balance and leg strength at a kitchen counter, then mat work for your trunk and hips.
25 minBeginner17 movesWall, bench or boxThis 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.
If someone with CP has a seizure, follow their own seizure plan and our epilepsy guide's first aid.
Chest pain that feels tight or spreads to the arms, neck or jaw, severe difficulty breathing, or someone has passed out and isn't responding normally.
Call 999 if:
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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The NHS: "If your symptoms change or get worse, you should see your doctor." NHS inform: "Contact your GP practice if:" you or your child "are experiencing a change in condition" or "have symptoms that are getting worse".
Stop if something hurts sharply, or for chest pain, dizziness or unusual breathlessness (our advice). You may take a splint or brace (orthosis) off if it causes pain that doesn't ease after repositioning the limb in it or adjusting the straps, and tell the team if it causes discomfort, sleep problems or sores.
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Scope's helpline is 0808 800 3333.
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There's no cure for CP, and the best Pilates trial found no change in walking. Pilates can be an enjoyable way to practise trunk control and balance.
Stretching on its own changes joint range by about 2 degrees, and evidence that it reduces spasticity in children with CP is limited. Medical treatments reduce spasticity; exercise doesn't.
Trials found no increase in spasticity with strength training.
Trunk training improved gross motor function a little in small trials, but Pilates hasn't changed walking in the best trial or in a review.
The trials used mat work, a ball and a wall with children with spastic CP, and none used a reformer.
Children and teenagers aged 7 to 18 took part in group and individual Pilates in four trials, with props and support.
No trial has included people who don't walk, so the evidence is missing, not negative. Seated breathing, trunk and arm work suits many people, with your team's advice.
It can be a good, enjoyable way to practise trunk control and balance, but it doesn't treat cerebral palsy. In the best-designed trial, 46 children who walk had no change in walking and only a small balance gain; smaller trials found more, often with extra exercise time. Use it alongside physiotherapy and strength training.
Balance may improve a little: a review of mostly Pilates studies in children found better balance but no change in walking, though we couldn't confirm exactly which studies it pooled. No trial has followed children after the classes ended.
Yes, adapted. Children aged 7 to 18 who walk took part in the trials, with balls, mirrors, a wall and small groups led by physiotherapists, and most who answered enjoyed it. Keep sessions short and playful, with an adult close by.
It may help balance: in one small study of 17 adults, which wasn't randomised, balance tests improved more in those who chose Pilates. In adults, exercise reliably builds strength, every kind studied appears safe, and the best choice is one you enjoy and can keep up.
The trials used the hundred with the head down, bridges, leg circles, toe taps, leg work on all fours, a twist, leg lifts sitting on a ball, a wall squat and heel-to-toe walking, about 10 of each. Our class adds sitting and standing options.
No trial has tested it. The springs can make some moves easier to grade, but the trials used mats, balls and walls. If you try one, choose a teacher who works with disabled people and start with lying footwork, which is our suggestion.
No study has shown that. The one trunk training trial that measured spasticity found no change, and stretching on its own makes little difference to tight muscles. Some people use their spasticity to stand and walk.
Stretch for comfort, slowly and never forced, as part of daily life. On its own, stretching changes joint range by about 2 degrees; your team's positioning, splints and strength work do more.
Usually, if nothing is forced. About 1 in 3 children with cerebral palsy develop hips that move out of place, so if your child has hip pain, or sitting, standing or walking gets harder, tell the team before carrying on.
Yes: seated breathing, sitting tall, marching, twists and arm work, with the brakes on. No Pilates trial has included people who don't walk, so ask your physiotherapist what suits you.
No trial has compared them. Strength training has the better evidence for building strength, and it doesn't make spasticity worse; Pilates adds trunk control and balance practice. Many people do both.
Two or three sessions a week is a reasonable start; the trials ran 2 or 3 sessions a week for 4 to 12 weeks. Start gently for the first few weeks, and stop for sharp pain, chest pain or dizziness.
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.
