Pilates guide
Pilates is a safe, adaptable way to stay active with Crohn's disease or ulcerative colitis for most people, especially between flares, and the UK's stoma nurses recommend Pilates-style core exercise for anyone who has had bowel surgery or has a stoma. It doesn't treat inflammatory bowel disease (IBD): no trial has tested Pilates in Crohn's or colitis, and your medicines and IBD team carry the treatment. Exercise trials in IBD are small, but they found modest benefits and no sign that sensible exercise sets off flares.
Crohn's disease and colitis are not the same as irritable bowel syndrome (IBS), which doesn't inflame the gut; if that's you, see our Pilates for IBS guide.
This guide covers what exercise does and doesn't do, Pilates on a flare day, fatigue, the core after surgery and with a stoma using the stoma nurses' levels, hernias, bones and steroids, joints and the back, a 25-minute class with a flare-day stop point, and the warning signs that need help.
Crohn's disease and ulcerative colitis are inflammatory bowel disease (IBD), lifelong conditions with flare-ups and quiet spells, treated with medicines and sometimes surgery; the NHS says IBD is different from IBS. No study has tested Pilates in Crohn's or colitis, so it's a way to stay active, not a treatment.
Across 15 studies (637 people, mostly in remission or with mild disease), structured exercise lowered disease activity slightly, at low certainty, without clearly changing quality-of-life scores; it eased anxiety and didn't raise inflammation. Crohn's & Colitis UK says exercising is safe and shouldn't cause a flare-up.
Breathing, gentle moves and short walks, or rest. Long or hard sessions wait: four days of long walks raised Crohn's symptom scores in one study.
The UK stoma nurses' recommendations (EXPASS) say gentle core exercises can start about 24 hours after surgery and build through set levels, with Pilates or similar highly recommended 2 to 3 times a week after that. They're expert consensus, funded by stoma product companies, not trial results. Up to 1 in 3 people with a stoma get a hernia beside it, and a small Pilates-based programme was workable for people who already had one.
About 35% to 40% of people with IBD have low bone density, and steroids add to the risk. In 47 adults with Crohn's disease, 6 months of impact and resistance training raised spine bone density and muscle function. Only 2 trials have tested exercise for bone in IBD, so pair Pilates with standing strength work.
Our 25-minute class pairs the stoma nurses' core levels 2 and 3 with standing strength for bones and muscles, and stops after the breathing on a flare day. Its structure is our own and untested.
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Crohn's disease can inflame any part of the gut, from the mouth to the bottom; ulcerative colitis inflames the large bowel and rectum. Both cause diarrhoea (sometimes with blood), tummy pain, tiredness and weight loss, and can affect the joints, eyes and skin. They come and go in flare-ups, lasting days to months, and spells of remission. There's no cure: medicines keep it quiet, and some people need surgery, sometimes with a stoma.
IBS doesn't inflame or damage the gut; IBD does, and is treated differently. Some symptoms overlap, and tiredness is about as common in IBS as in IBD, but the two are different conditions.
Crohn's & Colitis UK says fatigue affects around 7 in 10 people in a flare and 4 in 10 in remission, and about 1 in 3 people with IBD have anaemia. Across 20 studies, 47% of adults with IBD had fatigue, rising to 72% with active disease.
The British guideline says 35% to 40% of people with IBD have thin bones (osteopenia) and 15% osteoporosis, with steroids, inflammation and too little weight-bearing exercise among the causes; NICE calls Crohn's disease a cause of secondary osteoporosis. Fracture risk is a little higher (all fractures 13% higher across 11 cohorts). Low muscle mass on scans was common in mostly hospital-based studies.
Up to 46 in 100 people with IBD may have joint problems. Across 71 studies, about 10% had inflammation of the joints at the base of the spine (sacroiliitis), 3% ankylosing spondylitis and 13% arthritis in other joints. Crohn's & Colitis UK says medicines, exercise and physiotherapy all help.
No Pilates trial in Crohn's or colitis, small trials of other exercise, and expert consensus for stomas.
Our searches found no Pilates trial in Crohn's disease, ulcerative colitis or IBD, published or registered, and a 2026 review of 34 activity studies in IBD found none either.
Across 15 studies (637 people), exercise lowered disease activity slightly (6 trials; low certainty) without clearly changing quality-of-life scores (very low certainty). In quiet or mild disease, it eased anxiety a little and every trial judged it safe. A 2026 analysis of 24 trials (1,557 people) found aerobic exercise improved quality of life, with low or very low confidence in many comparisons, and exercise and mind-body movement eased low mood across 7 trials. Cochrane's review is still only a protocol.
Exercise didn't raise inflammatory markers in 5 studies. Among 1,857 people in remission, the more active were less likely to have a Crohn's flare 6 months later (a link, not proof). Very long efforts are different: four days of 30 to 50 km walks raised Crohn's symptom scores, though gut inflammation didn't change. One running trial counted 2 flares.
Walking 3 times a week improved quality of life in 32 people with Crohn's disease; muscle training had far fewer dropouts than endurance training (13% against 47%) in 45 people; and short hard intervals were feasible in 36. All small trials, mostly in quiet disease.
In 47 adults with stable Crohn's disease, 6 months of impact and resistance training, 3 hours a week, raised spine bone density and improved muscle function by 22.6% to 48.2%, with less fatigue. A year of low-impact exercise didn't raise bone density overall in 117 people, though gains tracked how many sessions people did. Only these 2 trials exist, at very low certainty.
In the Cochrane review, one trial of 45 people found physical activity advice may reduce fatigue, but the evidence is very uncertain. The British guideline suggests looking for causes first, then stress management, supportive therapy or gradually built-up exercise for fatigue that doesn't lift.
In 77 people with colitis in remission, 12 weekly yoga classes improved quality of life more than written advice, and lower stress explained the effect; there were 3 serious events with yoga against 1. Yoga-based practice eased anxiety and stress across 7 trials, but mindfulness and yoga didn't improve physical symptoms. Cochrane found talking therapies help quality of life and mood a little, with little to no effect on the disease itself. Our yoga for Crohn's disease guide covers yoga.
In a 2026 pilot of 26 people with mild or moderate IBD, 15-minute exercise videos aimed at the tummy, inspired by yoga, went with more remission in Crohn's disease (75% against 14% with general exercise). We could read only its abstract, it was tiny and lasted 4 weeks, so it needs repeating before anyone relies on it.
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Medicines to reduce inflammation and calm the immune system, and sometimes surgery, treat Crohn's and colitis. Exercise and Pilates sit beside them.
If you feel up to it, swap long or hard sessions for short walks, gentle stretching and breathing, and rest when you need to: Crohn's & Colitis UK says, "If you're not feeling up to it, don't put pressure on yourself." Drink plenty of fluids if you have diarrhoea, and build back up gradually as the flare settles (our editorial advice).
The American College of Sports Medicine says, "During a flare-up, modify your activity." Crohn's and Colitis Canada suggests low-impact activity such as walking or light yoga, and Crohn's & Colitis Australia strength maintenance and low-impact activity. In Pilates terms, that's the breathing and level 1 moves, a short walk, or rest (our suggestion).
Bloody diarrhoea, a high temperature, a fast heartbeat or severe tummy pain need medical advice, not exercise (see the warning signs). See a GP or your IBD team if your symptoms are getting worse or your treatment isn't helping.
The NHS says drink plenty of fluids to stay hydrated if you have diarrhoea. Dark yellow pee or peeing less than normal needs an urgent GP appointment or NHS 111 (the warning signs below).
EXPASS, the 2025 recommendations of the Association of Stoma Care Nurses UK, says exercise is safe and essential after stoma surgery, and specific core rehabilitation should be standard for everyone. Gentle core exercises can start about 24 hours after surgery and build through 5 levels, with core training kept up for life. It calls Pilates "an excellent choice for anyone with a stoma", suggests a class described as clinical or physiotherapy led at a beginner level, and highly recommends appropriate Pilates or similar 2 to 3 times a week. It's the agreed view of experts, funded by stoma product companies with their links declared, not trial evidence.
Level 1 keeps your head and feet down (breathing, knee rolls, leg slides, pelvic tilts); level 2 lets one foot lift (bridges, cat-cow, knee lifts); level 3 adds a small head lift or both feet up, not both (dead bugs, curl-ups, planks on your knees); levels 4 and 5 bring in the half roll back, planks, the hundred and roll-ups. Move up only when the level you're on feels controlled with no doming. Our core exercises after bowel surgery and levels 3 and 4 classes follow them.
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Ease back, or drop a level, if you notice any of these during or after exercise (EXPASS's self-check):
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The NHS says avoid strenuous activity or heavy lifting for 3 months after an ileostomy; Crohn's & Colitis UK says nothing heavier than a full kettle for the first 4 to 6 weeks; EXPASS says the evidence doesn't support a set weight limit or timeframe, and teaches lifting with breathing and tummy control. Follow your own surgical team or stoma nurse first.
The Ileostomy and Internal Pouch Association says double leg raises and sit-ups are not recommended after abdominal or pelvic floor surgery, and that people with an internal pouch should avoid pelvic floor squeezes unless their consultant recommends them.
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Crohn's & Colitis UK says up to 1 in 3 people with a stoma get a hernia, and suggests tummy-strengthening exercises, a healthy weight and not smoking to lower the risk. In a US survey of 443 people, 29.7% reported one, and they exercised less, which can't show cause. Exercise ranked well for prevention in a 2025 analysis, but on only 3 weak studies, so it's plausible and unproven. Surgeons use a mesh to prevent some hernias.
In Scotland, adults with a stoma and a bulge or hernia followed a Pilates-based programme: a booklet, 13 videos and up to 12 weekly online sessions with a clinical exercise instructor. 19 of 28 referred completed it, there were no serious adverse events, and people said they felt more control and confidence. It was a feasibility study, not designed to show benefit, and nobody measured hernia size.
Colostomy UK says once you've recovered, and with your doctor's or stoma nurse's agreement, there's no reason why you shouldn't play competitive sport. Empty your bag before class, tell the teacher privately if you want to, and swap face-down moves for all-fours versions if lying on your stoma is uncomfortable (our suggestion). Colostomy UK's older Pilates sheet advises against high-impact sport, which its newer page and EXPASS no longer do.
From EXPASS's breathing advice, as our Crohn's and colitis exercise guide teaches it; 5 breaths is our starting point.
See the movement on the 3D figure: Lateral breathing (Pilates breathing)
Lateral breathing, 5 to 8 breaths at the start of every session (the move page's dose); side-lying tummy draw-in, 3 to 5 holds of 5 to 10 s, and pelvic tilts, 3 to 5 reps holding 5 to 10 s, tilt only at level 1 (our core exercises after bowel surgery class); knee rolls (hip windshield wipers), heel slides, knee fall-outs, knee folds and glute bridges, 3 to 5 reps each (our core exercises after bowel surgery class); cat-cow, 4 to 6 slow reps (our core exercises after bowel surgery class).
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoSide-lying tummy draw-inBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoHip windshield wipersBeginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoBent-knee fall-outBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoGlute bridgeBeginner · No equipment
3D demoCat-cowBeginner · No equipmentDead bug heel taps, 5 to 8 each side; chest lift, 5 to 8; knee plank, 3 holds of 10 to 20 s; knee side plank, 2 holds of 10 to 20 s each side; knee hover, 3 to 5 holds of 5 to 10 s; half roll back, 5; single-leg stretch, 6 to 10 switches (all from our core exercises with a stoma: levels 3 and 4 class). The hundred, 50 beats to start, building to 100 (the move page's dose), head down first, comes at levels 4 to 5.
3D demoDead bug heel tapsBeginner · No equipment
3D demoChest lift (Pilates curl-up)Beginner · No equipment
3D demoKnee plankBeginner · No equipment
3D demoKnee side plankBeginner · No equipment
3D demoKnee hover (Pilates tabletop hover)Beginner · No equipment
3D demoHalf roll back (Pilates C-curve roll back)Beginner · No equipment
3D demoSingle-leg stretch (Pilates one leg stretch)Intermediate · No equipment
3D demoHundred (Pilates)Intermediate · No equipmentThe British guideline advises people who need steroids to do regular muscle-building and weight-bearing exercise such as weight training or running, and the UK osteoporosis guideline recommends combining weight-bearing and muscle-strengthening exercise. Crohn's & Colitis UK says weight-bearing exercise keeps bones strong.
Mat Pilates is light work (1.8 to 2.8 METs) and has no impact, while the bone trial in Crohn's disease used impact and resistance training. So use standing strength moves in a Pilates class, and add our bone-strengthening workout when your team agrees (our reading).
With osteoporosis, use the head-down versions of curl-ups and leave out roll-ups and rolling moves, as the move pages say; our Pilates for osteoporosis guide has the full swaps. New hip, groin or knee pain on steroids needs checking. Don't stop taking steroids without talking to your doctor.
Sit to stand, 8 to 10 slow reps, and hip-hinge practice, 8 slow reps (our Pilates for osteoporosis class); slow calf raise, 12 (our Pilates for hikers class); wall push-up, 2 sets of 8 to 10, and band row, 2 sets of 10 to 15 (our Pilates for office workers class); single-leg stand, 2 holds of 20 to 30 s each leg, beside a wall or worktop (our Pilates for osteoporosis class).
Back pain that started before 45, has lasted more than 3 months and gets better with exercise but not rest needs checking by your IBD team or GP: it can be inflammation of the spine. Exercise and physiotherapy are part of treatment, and our Pilates for ankylosing spondylitis guide has a spine-extension class.
Crohn's & Colitis UK suggests exercising in the morning when stiffness is worst may help. A joint that suddenly becomes red and swollen with a high temperature needs urgent advice (below).
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Breathing and level 1 moves, a short walk, or rest. No curls, roll-ups or face-down moves on a painful tummy (our suggestion).
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Start at level 1 and follow your team's timing. No sit-ups or double leg raises while your tummy heals; advanced moves such as V-sits and hanging leg raises come last and may not suit everyone.
Keep to the levels you can do without extra doming; a support garment is a personal choice for comfort.
Pelvic floor squeezes only if your consultant recommends them.
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Shorter sessions and the flare-day block on bad days, and get the causes of tiredness checked (our suggestion).
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Our 25-minute remission-day class pairs core levels 2 and 3 with standing strength, and stops after the breathing on a flare day; its structure is our own and untested. The two stoma core classes are the stoma nurses' levels, the tummy surgery class is a staged return after any operation, the osteoporosis class has the bone-safe swaps, the bone workout adds impact and heavier strength, and the bedtime class suits flare days.
A 25-minute Pilates class for Crohn's disease and colitis in remission: breathing with your core, stoma-safe core levels, standing strength and a flare-day stop point.
25 minBeginner16 movesBench or box, wallA gentle 20-minute core routine for the weeks after bowel or stoma surgery: breathing, tummy and pelvic floor work lying down, then chair and standing moves.
20 minBeginner14 movesBench or box, wallThe next step after the first core routine: 20 to 30 minutes of level 3 and 4 core work, 2 to 3 times a week, from the UK stoma nurses' recommendations.
25 minIntermediate14 movesNo equipmentA 25-minute Pilates return class after keyhole gallbladder removal or a hernia repair: knees-bent moves, then side-lying and standing work, then first curls.
25 minBeginner17 movesBench or box, wallA 25-minute Pilates workout for osteoporosis and osteopenia: the Royal Osteoporosis Society's swaps for rounding moves, plus back strength and balance.
25 minBeginner16 movesWall, bench or boxImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesKettlebell, other / check instructionsA slow 15-minute Pilates wind-down for the last hour before bed: slow breathing, small lying moves and a few minutes of stillness, with no effort or holds.
15 minBeginner9 movesFirm cushionThe beginner plan builds the basics over 4 weeks, for people in remission without recent surgery; after surgery, start with the stoma core classes.
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.
Don't drive yourself; ask someone to drive you or call an ambulance, and bring your medicines. Go now if:
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Throbbing pain and swelling in one leg, usually the calf or thigh, can be a blood clot: ask for an urgent GP appointment or call NHS 111, and call 999 if you're also short of breath or have chest pain.
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Don't stop taking steroids without talking to your doctor: if you've taken them for more than 3 weeks or at a high dose, they usually need to be reduced gradually.
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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 lists depression and anxiety among the complications of ulcerative colitis, and our anxiety and depression guides can help. If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E. For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988.
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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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Crohn's & Colitis UK says exercise is safe and shouldn't cause a flare-up, and in small trials, mostly in remission or mild disease, exercise helped a little without raising inflammation. Scale back in a flare.
No trial has tested Pilates in IBD. Medicines carry the treatment, and even talking therapies have little to no effect on the disease itself.
The more active had fewer Crohn's flares in a large study (a link), one running trial counted 2 flares, and very long walks raised Crohn's symptom scores. Gentle and moderate exercise in remission isn't the problem; very long or hard efforts can be.
The stoma nurses recommend core exercise for everyone with a stoma, and a Pilates-based programme had no serious adverse events in people who already had a hernia.
Unproven: the exercise studies are few and weak, and the stoma nurses say core work potentially reduces the risk. An older charity sheet's claim that Pilates can help prevent a hernia has no evidence behind it.
It's the other way round: the British guideline advises muscle-building and weight-bearing exercise such as weight training or running for people on steroids. Follow our osteoporosis guide's limits if your bones are already thin.
The stoma nurses' levels are mat, seated and standing moves, and the HALT programme was delivered at home with videos and online sessions.
It's a safe, adaptable way to stay active for most people, especially in remission, and the UK's stoma nurses recommend Pilates-style core work after bowel surgery. No trial has tested Pilates in Crohn's disease, and it doesn't treat the disease.
The same applies: exercise is safe for most people and helped a little in small trials, and in one trial yoga improved quality of life in colitis. Pilates itself hasn't been tested in colitis.
Scale back to breathing, gentle moves and short walks, or rest if you need to. Severe tummy pain, bloody diarrhoea, a high temperature or a fast heartbeat need medical advice, not exercise.
In small trials, mostly in remission, exercise didn't raise inflammation, and the more active had fewer Crohn's flares in a large study. Very long efforts are different: four days of long walks raised Crohn's symptom scores.
Yes. The UK stoma nurses call Pilates an excellent choice for anyone with a stoma and suggest a clinical or beginner class, starting with their core levels. Empty your bag first, and ease off at any doming or bulging.
Gentle core exercises such as breathing, pelvic tilts and knee rolls can start about 24 hours after surgery, then build through the levels. Follow your own team's advice on lifting and when to return to classes.
Nothing in the evidence rules it out, but start on the mat or with a clinical teacher at your level, and skip any move that makes your stoma dome or bulge. The stoma nurses suggest classes described as clinical or physiotherapy led.
It isn't proven. The stoma nurses recommend core exercise for everyone with a stoma, and a Pilates-based programme was safe in people who already had a hernia, but the prevention studies are few and weak.
Probably not on its own. Impact and resistance training raised spine bone density in Crohn's disease, and the British guideline advises weight-bearing and muscle-building exercise, especially on steroids. Add standing strength or our bone workout.
Fatigue is very common, so get the causes checked first, such as anaemia or active disease. Activity advice may help, but the evidence is very uncertain; short, gentle sessions on tired days are a reasonable start.
No. Crohn's disease and colitis inflame the gut and IBS doesn't, and the NHS says they're different conditions, though some symptoms overlap.
In a flare, long or hard sessions. After surgery, sit-ups and double leg raises until your team says otherwise, and with an internal pouch, pelvic floor squeezes unless your consultant recommends them. With thin bones, roll-ups and rolling moves.
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.
