Pilates guide
High cholesterol causes no symptoms, and only a blood test shows it. Pilates is good for strength, balance and posture, but it does little for cholesterol on its own: in the two small trials in people with mostly high cholesterol, LDL (the "bad" cholesterol) didn't fall. Exercise in general lowers LDL a little, about 6% across 148 trials, and brisk walking or other cardio does most of that work.
This guide explains what Pilates can and can't do for LDL, HDL and triglycerides, why to pair it with cardio, how it compares with a statin, exercising on a statin when your muscles ache, the moves and classes to follow, and the warning signs that need help. Pilates goes alongside a statin or other treatment your doctor recommends, never instead of it.
In the two small trials in people with mostly high cholesterol, Pilates didn't lower LDL. A review of 15 small trials found blood fats a little lower overall, but the trials were short, small and mostly unblinded.
Pilates uses about 2 to 3 METs (a measure of effort, where sitting still is 1), against about 5 for brisk walking. The NHS counts it as muscle-strengthening, so you still need 150 minutes of moderate cardio a week.
Across 148 trials, exercise training lowered LDL by about 0.19 mmol/L (about 6%), and cardio combined with strength work did best. In one comparison, Nordic walking lowered LDL more than Pilates.
The British Heart Foundation says statins lower LDL by up to 30%, or more than 40% at high doses. NICE (the National Institute for Health and Care Excellence) asks doctors to discuss lifestyle first, then offer a statin. Pilates goes alongside one, never instead.
In blinded trials, muscle pain or weakness was reported almost as often on a dummy pill as on a statin: only about 1 in 15 of those reports was caused by the statin. Tell your GP about unexplained aches rather than stopping the tablet.
As your strength work on 2 days a week, with brisk walking, cycling or swimming on most days. Our walk and Pilates class puts both in one session.
Our exercise for high cholesterol guide explains each number on your test in more detail.
The NHS: "High cholesterol is when you have too much of a fatty substance called cholesterol in your blood." and "Too much cholesterol can block your blood vessels. It makes you more likely to have heart problems or a stroke."
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"High cholesterol does not usually cause symptoms. You can only find out if you have it from a blood test."
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For healthy adults, the NHS gives total cholesterol below 5 mmol/L, HDL ("good") cholesterol above 1.0 mmol/L for men or 1.2 for women, and non-HDL ("bad") cholesterol below 4. Your own target depends on your risk, which your GP can work out with a QRISK score.
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The NHS lists being over 50, a man, after the menopause, or of South Asian or sub-Saharan African origin, and says "It can also run in families." Slim, active people can have it too, especially inherited high cholesterol (familial hypercholesterolaemia, FH).
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The NHS's list: eat less saturated fat, exercise more (at least 150 minutes of moderate exercise or 75 minutes of vigorous activity a week), stop smoking and cut down on alcohol. Pilates fits under the exercise part, as strength work.
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In Brazil, sedentary women aged 60 to 75 with high cholesterol did Pilates 2 or 4 times a week for 10 weeks; total cholesterol, LDL, HDL and triglycerides didn't change, though their walking fitness improved. Its registration describes 26 women, not randomised, with statin users excluded; the paper's abstract says 35 women and randomised, so the two disagree. In 44 postmenopausal women, 86% with high cholesterol, 12 weeks of mat Pilates 3 times a week lowered LDL by 7 to 10 mg/dL (about 0.2 mmol/L), which wasn't significant, and there was no group without exercise.
A 2021 review of 15 small trials (587 people) found total cholesterol about 0.5 mmol/L lower, LDL about 0.3 mmol/L lower and triglycerides a little lower with Pilates than without, and no change in HDL. Only 5 trials described how they randomised and one described blinding. The review split its results by diabetes, but its text and table disagree on which trials sit where, so we don't rely on that split.
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Of 17 single Pilates trials we found, most found no significant change in LDL, including trials in women with obesity and in people with type 2 diabetes or prediabetes. Two found HDL a little higher and nothing else. One trial in women with prediabetes reported large falls, with effects bigger than 16 weeks of exercise would be likely to produce (our reading).
In 196 overweight postmenopausal women (not randomised), 10 weeks of Nordic walking lowered LDL by 12.8% and Pilates by 7.5%, and walking did significantly better.
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In type 2 diabetes, a network analysis of 52 trials ranked Pilates highly for total cholesterol and triglycerides, but its authors say the ranking "needs to be rationalized", and we couldn't read how many Pilates trials it held.
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Across 148 trials (8,673 people), exercise training lowered LDL by 7.22 mg/dL (0.19 mmol/L) and raised HDL by 2.11 mg/dL, and the authors call combined cardio and strength training optimal. HDL rose with about 120 minutes of aerobic exercise a week or more, and in an 8-month trial the largest amount of exercise did most.
The 148-trial review puts exercise's LDL fall at about 6%, against the 50% target for cholesterol medicines. The British Heart Foundation says low-dose statins lower LDL by up to 30% and high-dose statins by more than 40%. No trial has compared Pilates with a statin.
At least 150 minutes of moderate activity a week, such as brisk walking, plus muscle-strengthening on 2 days. NICE asks doctors to advise both for people at higher risk of heart disease.
Count 2 Pilates sessions a week as your strength work. A gentle mat class doesn't count towards the 150 minutes: the Compendium of Physical Activities puts mat Pilates at 1.8 METs and Pilates in general at 2.8, and moderate starts at about 3. Standing strength moves, short rests and a band make Pilates work harder.
Walk fast enough that you can talk but not sing, cycle or swim on most days. Our walk and Pilates class starts with a 20-minute brisk walk, then a short-rest Pilates circuit (our editorial structure).
The Pilates trials ran for 8 to 16 weeks, and the exercise trials for months. Ask your GP when to repeat the test; food, weight, alcohol, smoking and medicines move LDL more than exercise does.
In 19 blinded trials (123,940 people), muscle pain or weakness was reported by 27.1% on a statin and 26.6% on a dummy pill, so only about 1 in 15 of those reports was caused by the statin, mostly in the first year. In people who had stopped statins because of aches, statin months and dummy-pill months felt the same. NICE says the risk of muscle symptoms from a statin is small.
Six months of high-dose atorvastatin didn't change muscle strength or exercise capacity in 420 healthy adults. In one small trial, simvastatin blunted fitness gains from 12 weeks of aerobic training. In 10,043 US veterans with high cholesterol, statins and fitness were each linked with lower death rates, and the two together with the lowest; it's an observational study, so it can't prove cause.
A European consensus says small rises in creatine kinase (a muscle enzyme in the blood) with muscle symptoms are often due to more exercise, and HEART UK lists heavy exercise among things that make statin side effects more likely. A Pilates class at a moderate pace isn't heavy exercise (our reading); mention any hard session before a blood test.
The NHS says: "If you stop taking statins your cholesterol levels may be affected. Talk to a doctor or pharmacist before stopping." Exercise doesn't replace a statin your doctor recommends; it works alongside it.
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No reformer trial has been done in people with high cholesterol. In 40 young medical interns, 8 weeks of reformer Pilates raised HDL a little and changed nothing else. The springs make it easier to add resistance, which helps it count as strength work (our reading).
Measured sessions averaged about 3 METs in the most careful estimate, and some faster classes more. Even so, add separate cardio: no Pilates format has been shown to lower LDL.
Brisk walking on most days, building to 150 minutes a week (the NHS's target): treadmill or outdoors, 20 minutes at a pace where you can talk but not sing, and a 2-minute standing march to warm up or on days you can't get out (our walk and Pilates class's doses).
Breathe out on the effort and never hold your breath. Hundred: "50 beats to start, building to 100" (the move page's dose), head down if your neck tires. Single-leg stretch: "6 to 10 each side" (the move page's dose). Pelvic tilt into bridge: 8 slow reps; sit to stand: 2 sets of 10; bodyweight squat: 10 reps; wall push-up: 2 sets of 10 (our classes' editorial starting points). Side kick: "8 to 10 each side" (the move page's dose). Swimming: "2 to 3 sets of 20 to 30 seconds" (the move page's dose). Knee hover: "3 holds of 15 to 30 seconds" (the move page's dose). Band row: "3 sets of 10 to 15" (the move page's dose).
3D demoHundred (Pilates)Intermediate · No equipment
3D demoSingle-leg stretch (Pilates one leg stretch)Intermediate · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoKnee hover (Pilates tabletop hover)Beginner · No equipment
3D demoSit to stand from a chairBeginner · A bench or box
3D demoBodyweight squatBeginner · No equipment
3D demoWall push-upBeginner · A wall
3D demoBand rowBeginner · A band + An anchor pointMermaid: "3 each direction, each side" (the move page's dose). Spine twist: "3 to 4 each side" (the move page's dose).
Don't. Breathe out on the effort: holding your breath while straining raises blood pressure sharply, as our Pilates for heart health guide explains.
Follow our Pilates for heart health guide and its class instead of a general mat class. The knee hover and leg pull front carry their own caution: with heart disease, keep breathing and ask your cardiac team before long holds, and with heart failure, avoid planks.
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The roll-over and jack knife take your head below your heart; their own cautions say to skip them with glaucoma unless your eye specialist agrees. Our Pilates for high blood pressure guide lists the moves to change.
Do lighter sets with more rest that day and tell your GP; no move is off limits (our suggestion). Call NHS 111 for the serious signs below.
The walk and Pilates class is the one to start with: the 20-minute brisk walk counts towards your 150 minutes a week, and the Pilates circuit counts as strength work. Its intro talks about weight loss; for cholesterol, the same mix of cardio and strength is what the trials support. The heart health class suits anyone with heart disease, and the high blood pressure and diabetes classes keep your head up.
A 45-minute session for weight loss and health: a 20-minute brisk walk, which does more for the scales, then a short-rest Pilates circuit for strength.
45 minBeginner11 movesCardio machineA 30-minute Pilates strength class with dumbbells or a band: Pilates trunk work plus squats, lunges, rows and push-ups, each set taken until it is hard.
30 minIntermediate15 movesA dumbbell, A bandA 40-minute Pilates class for heart conditions: a 15-minute warm-up, standing strength, head-level mat work with no planks or breath holds, and a seated cool-down.
40 minBeginner22 movesA bench or box, A wallA 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 30-minute Pilates class for type 2 diabetes: standing strength in your shoes, then mat work for hips, back and trunk, head up throughout and finishing seated.
30 minBeginner16 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 40-minute walk alternating 3 minutes fast and 3 minutes easy, five times over: the interval walking tested in Japanese trials, built up from three rounds.
40 minBeginner3 movesCardio machine, A wallThe walking plan builds to 150 minutes a week over 8 weeks; the beginner Pilates plan teaches the basics 3 days a week.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 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 minBeginnerHigh cholesterol has no symptoms of its own, so these are the heart, stroke and statin lines from our exercise for high cholesterol guide, word for word, with the chest pain and fainting lines from our other Pilates guides. 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.
Call 999 if:
Call 999 for any of these, and don't drive yourself to A&E:
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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Stop if you get chest pain, palpitations, dizziness or light-headedness. If it doesn't go away quickly with rest, or with your GTN if you use it, get urgent medical advice.
Stop exercising if you get chest pain, unusual breathlessness, dizziness or palpitations, and use the 999 and 111 advice above (our suggestion, as in our other heart guides).
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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The two trials in people with mostly high cholesterol found no significant fall in LDL, and the small falls in pooled trials come from short, small, unblinded studies. That agrees with our Pilates for heart health guide.
The one reformer trial, in young adults, changed only HDL, and no reformer trial has been done in people with high cholesterol.
Mat Pilates is about 2 to 3 METs, and the NHS counts Pilates as muscle-strengthening, on top of 150 minutes of aerobic activity.
Exercise lowered LDL by about 6% across 148 trials. NICE offers statins when lifestyle changes aren't enough, and the NHS says to talk to a doctor or pharmacist before stopping one.
Most aches on a statin aren't caused by it, high-dose atorvastatin didn't reduce strength or exercise capacity, and HEART UK encourages people on statins to be more physically active.
Not on its own, as far as trials show. In the two small trials in people with mostly high cholesterol, LDL didn't fall significantly, and pooled trials found only small changes. Pair Pilates with brisk walking or other cardio, which does more.
It's good for strength, balance and staying active, which matter for your heart. For the cholesterol number itself, cardio, food, weight and, if you need one, a statin do most of the work.
No reformer trial has been done in people with high cholesterol. In young adults, 8 weeks on the reformer raised HDL a little but didn't change LDL.
That's the right mix: about 150 minutes of moderate cardio a week, such as brisk walking, plus strength work on 2 days, which Pilates can be. Combined cardio and strength training did best across 148 trials.
Twice a week counts as your strength work. The Pilates trials used 2 or 3 sessions a week for 8 to 16 weeks, but for blood fats the total amount of cardio matters more.
Yes. In blinded trials, most muscle aches on statins weren't caused by the statin, and a high dose didn't reduce strength or exercise capacity. If you get unexplained muscle pain or weakness, tell your GP rather than stopping the tablet.
No. Exercise lowers LDL by a few per cent, and statins by 30% or more. The NHS says to talk to a doctor or pharmacist before stopping a statin.
Neither has been shown to do much on its own, and they haven't been compared with each other. Choose the one you'll keep doing, and add cardio; our yoga for high cholesterol guide covers yoga.
A couple of small trials found HDL a little higher, but the pooled trials didn't. In aerobic exercise trials, HDL rose with about 120 minutes or more a week.
Trials measured it after 8 to 16 weeks. Ask your GP when to repeat the test; food, weight, alcohol, smoking and medicines change it more than exercise does.
Yes, the same as anyone else. FH needs treatment from early on, and exercise works alongside it; mention hard training or competitive sport at your lipid clinic, as our exercise for high cholesterol guide suggests.
Stop for chest pain, unusual breathlessness, dizziness or palpitations. Call 999 for chest pain that doesn't go away or spreads, or for signs of a stroke, and call NHS 111 for statin muscle pain with weakness or red or brown pee.
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.
