Pilates in eating disorder recovery: when movement helps and when it harms, working with your treatment team, and a gentle routine

Get help straight away

Our suggestion, in the NHS's words: "A mental health emergency should be taken as seriously as a physical one. You will not be wasting anyone's time."

• Call 999 or go to A&E (accident and emergency) now if someone's life is at risk, for example they have seriously injured themselves or taken an overdose, or if you do not feel you can keep yourself or someone else safe.
• For urgent help, get help from 111 online or call 111 and select the mental health option, or ask for an urgent GP appointment.
• Call 116 123 to talk to Samaritans. If you're under 19, you can also call 0800 1111 to talk to Childline.
• Text SHOUT to 85258.

Sources 1, 2

Talk to Beat

Talk in confidence to the eating disorder charity Beat: 0808 801 0677 (England), 0808 801 0432 (Scotland), 0808 801 0433 (Wales) or 0808 801 0434 (Northern Ireland), 3pm to 8pm, Monday to Friday. Calls are free, and Beat also has webchat and email. You don't need a diagnosis to get in touch. Beat isn't a crisis service, so if you're in danger, use the numbers above.

Source 3

Go to A&E or contact the eating disorder team straight away

The Royal College of Psychiatrists' guidance on medical emergencies in eating disorders (MEED) tells relatives and carers to go to A&E for assessment, or contact the eating disorder team immediately, for any of these:

MEED also counts struggling to get up from a squat, or to sit up from lying down, without using the arms as a sign of high risk. Someone can look well and full of energy and still be in danger, and normal blood tests don't rule it out.

• Fainting when standing up.
• Being unable to climb stairs.
• Talking about ending their life.
• Suddenly refusing all food or drink.
• A stomach bug or other illness with vomiting or diarrhoea.

Source 4

If you haven't had help yet

The NHS lists signs such as spending a lot of time worrying about your weight and body shape, exercising too much, and having very strict habits or routines around food. If that sounds like you, see a GP as soon as you can. You can also talk in confidence to the eating disorder charity Beat: 0808 801 0677 (England), 0808 801 0432 (Scotland), 0808 801 0433 (Wales) or 0808 801 0434 (Northern Ireland), 3pm to 8pm, Monday to Friday.

Sources 5, 3

Pilates isn't a treatment

NICE says physical therapies such as yoga or weight training shouldn't be offered as treatment for an eating disorder. Treatment is talking therapy with a specialist team, and family therapy for young people.

Sources 6, 7

Whether and when is your team's decision

General exercise advice can be harmful with an eating disorder. For many people a pause comes first, and Beat says that is fine.

Sources 8, 9

Gentle, supervised Pilates can be an early step

Once your team has checked your health, a guideline many teams use lists "gentle Yoga and Pilates" among early, supervised steps back to movement.

Source 10

The evidence is one small study

Twelve girls with anorexia, no comparison group, no significant change in eating disorder scores, and no harms. Supervised exercise in general looks safe in small trials but hasn't been shown to treat the illness.

Sources 11, 12, 13

Exercise can become part of the illness, even gentle exercise

About half of people with an eating disorder exercise excessively. Rigid rules, guilt, exercising when unwell and holds kept up through dizziness are signs.

Sources 14, 15, 8, 4

Recovery isn't about weight or shape

Beat: "Remember, the goal is not to lose weight." Choose the gentle end of Pilates, with no hot rooms, long holds, rolling or jumping, counting, trackers, mirrors or talk about appearance (our reading).

Sources 8, 16, 17

What an eating disorder is

The NHS: "An eating disorder is a mental health condition where you use the control of food to cope with feelings and other situations." They include anorexia, bulimia, binge eating disorder and other specified feeding or eating disorder (OSFED), the most common. "With treatment, most people can recover from an eating disorder." Men get eating disorders too: Beat cites an estimate of around 1 in 4.

Sources 5, 7, 18

Exercise can become part of the illness

The NHS lists "exercising too much" among the symptoms. Beat: "If you have an eating disorder, exercise can become driven, rigid, and compulsive, with activity levels becoming excessive and unsafe." Experts describe compulsive exercise as exercise you feel driven to do, by rigid rules or to manage distress, that carries on despite injury, illness or no enjoyment, and it can be vigorous exercise, a big increase in daily movement, or restlessness. Across 56 studies (21,518 people), nearly half of people with an eating disorder exercised excessively, most often in anorexia, though the studies varied a lot.

Sources 5, 8, 15, 14

How you relate to exercise matters more than how much

A 2026 clinical review: "Research evidence consistently shows that one's psychological relationship with exercise, more than exercise frequency or intensity, determines the extent to which exercise confers harmful or beneficial effects." Beat says exercise can be a problem "even if the type and quantity of exercise does not appear to be excessive in frequency, duration or intensity".

Sources 19, 8

Why Pilates needs care

Pilates is slow and low impact, which is why it appears among early steps back to movement. But Pilates as it's often sold can feed an eating disorder: toning and sculpting talk, "burn" talk, mirrors and comparison, counting repetitions and tracking classes, long holds and constant core bracing, and heated rooms. MEED, the Royal College of Psychiatrists' guidance on medical emergencies in eating disorders, counts "adopting fixed postures with isometric muscle contraction" as a kind of hidden exercise; applying that to Pilates holds is our reading, as MEED doesn't mention Pilates.

Sources 10, 17, 16, 8, 4, 20

The medical risks

The NHS lists anorexia's complications as including problems with muscles and bones and an irregular heartbeat and low blood pressure. MEED: "Patients with eating disorders can appear well and have normal blood tests, even if they are near to death." A slow heartbeat can happen whatever your weight, and after vomiting or laxatives, salt imbalances and water loss are made worse by exercise. With anorexia and osteoporosis, NICE advises avoiding high-impact activities and those that make falls or fractures more likely.

Sources 7, 4, 20, 6

What a Pilates class asks of the body

Getting down to the floor and back up, which can bring on dizziness with low blood pressure, lying and side-lying work, small holds and breathing in time with moves. MEED's bedside check of muscle weakness asks someone to sit up from lying without using their hands, which a Pilates roll-up looks like. Struggling with it is a sign to tell your team, never a goal to train or a test to set yourself (our reading).

Sources 4, 20

Pilates isn't a treatmentStrong evidence

NICE: "Do not offer a physical therapy (such as transcranial magnetic stimulation, acupuncture, weight training, yoga or warming therapy) as part of the treatment for eating disorders." It says nothing about Pilates; our reading is that the same applies.

Source 6

One small Pilates studyMixed evidence

Twelve girls with anorexia in a hospital child mental health unit in Spain did hour-long mat Pilates classes 3 times a week for 10 weeks, led by a physiotherapist, after their medical team approved it and alongside cognitive behavioural therapy (CBT). Eating disorder scores didn't change significantly, physical well-being improved, attendance was high, and "No adverse events occurred during the study."

The authors say that without a comparison group the changes "may not be unequivocally attributed to the Pilates program". It was registered after it ended, and two papers report the same 12 girls.

Sources 11, 21, 22

No trial of Pilates in any eating disorder

Our searches found no randomised trial and no review of Pilates in any eating disorder, and a 2022 review of exercise therapy in anorexia lists the pilot above as the only Pilates study.

Sources 23, 24

Supervised exercise looks safe in small trialsEmerging evidence

Across 11 trials in anorexia (290 people, mostly strength training, none of Pilates), exercise added to usual care was "well tolerated, with no adverse effects on weight restoration", improved muscle strength and didn't clearly change quality of life. Most of the trials were small, with some concerns about bias.

Sources 12, 25, 20

Exercise hasn't been shown to treat the illnessMixed evidence

Across 12 trials in diagnosed eating disorders, exercise or mind-body exercise "was not more effective than controls" for depression, harmful exercise habits, eating behaviours or managing emotions, at low to very low certainty. An older review of 8 trials was more positive but flagged bias.

Sources 13, 26

Yoga, the nearest relative: small, mixed trialsMixed evidence

In 54 young people, yoga alongside standard care reduced eating disorder symptoms more than standard care alone; other small trials were mixed, and reviews disagree about the effects. Movement awareness therapies have no high-quality trials. Our yoga for eating disorders guide has the detail.

Sources 27, 28, 29, 30, 31, 32

Body image: not shownMixed evidence

In the newest network analysis (23 trials, 1,914 women and girls), mind-body exercise "did not differ significantly from usual care" for body image, and it included no Pilates trial; the authors add that this isn't proof it doesn't work. A 2026 Pilates review couldn't pool body image results, and the small Pilates studies in women without an eating disorder are weak.

Sources 33, 34, 35, 36

NICE: stop excessive exercise

"Advise people with an eating disorder who are exercising excessively to stop doing so." NICE has no recommendation on supervised or graded exercise.

Source 6

A staged guideline many teams use

SEES-2 (Safe Exercise at Every Stage, 2025) has four levels. The first allows only still movement that doesn't make you dizzy when you change position. The next lists "gentle Yoga and Pilates" among low-impact, social activities. "Movement sessions should be supervised in the initial stages", and moving up a level needs your team to see that it's safe and that treatment is going well.

It's expert opinion, written to be used by "a trained medical or exercise professional". Don't turn its levels into a plan for yourself (our suggestion).

Source 10

Two views that fit together

NICE says stop excessive exercise and don't offer physical therapies as treatment; SEES-2 says "Movement is a positively indicated treatment component but is not compulsory". Our reading: Pilates isn't the treatment, and whether and when to move is your team's decision.

Sources 6, 10

Gentle activity can ease distress

MEED: "Some degree of gentle activity (watching TV with others, reading a book or doing crafts) or going for a brief walk with others (nursing staff or family) can help reduce distress without any additional risk", and enforced bed rest "is unhelpful and should be avoided".

Source 4

Beat: talk to your team, and a pause is OK

"It can be detrimental for someone with an eating disorder to follow general exercise guidance available to the general public, because it doesn't consider individual mental and physical health." Beat asks you to "discuss with your GP or eating disorders team to assess how much exercise you should engage in each week", and says "It may feel more beneficial for you to stop exercising while you focus on your recovery journey." Beat adds that this is fine.

Source 8

Eat as usual on Pilates days

Beat: "You need to remain nourished and hydrated with your usual meals and snacks alongside any exercise you do, as well as on rest days."

Source 8

Young people

The Royal College of Psychiatrists: "If you have been diagnosed with an eating disorder, this guidance may not apply. Please discuss this with your doctor. It is ok to take time away from physical activity to promote your recovery from an eating disorder."

Source 9

How teams bring movement back

Reviews suggest starting with "short bouts of mild intensity activities", with safety first, often in hospital or residential care. There's no agreed best practice yet; a scoping review found that teaching about exercise and planned movement sessions helped manage unhealthy exercise.

Sources 37, 19, 38

Signs to look out for

Beat lists "Engaging in rigid/repetitive or punitive exercise", "Exercise performed despite injury or illness", and feeling it's not possible to change a session or try anything new. It suggests you "consider how anxious you would feel if you were prevented from exercising". In Pilates, that can look like never missing a class, adding classes after eating, holding moves through dizziness, or counting repetitions and classes (our reading).

Source 8

Gentle can still be driven

Compulsive exercise includes a "marked increase in daily movement" and "motor restlessness", not only hard exercise. MEED's examples of hidden exercise include fixed postures held with muscles tensed; our reading is that long Pilates holds and bracing all day can count.

Sources 15, 4

Why it matters

Compulsive exercise is linked with longer hospital stays, a longer illness and relapse, and in one small study, excessive exercise straight after leaving hospital predicted relapse. These studies show links, not cause.

Sources 39, 40

Treatment can help a littleMixed evidence

In the largest trial (207 inpatients with anorexia), a group combining talking therapy with exercise work reduced compulsive exercise a little. Adding a similar programme to CBT in 78 adults made no clear difference on the main measure, though later analyses found less rule-driven exercise, and a trial in teenagers was too small to tell. Ask your team what they offer.

Sources 41, 42, 39, 43

No scores here

Clinicians measure compulsive exercise with a questionnaire, the Compulsive Exercise Test. We don't reproduce it, because a score can become a target (our suggestion).

Source 44

Long holds and held curls

The hundred, planks and long side planks. MEED counts fixed postures with tensed muscles as hidden exercise (applying that to Pilates is our reading), and yoga experts named "long-holding postures" as unsuitable in anorexia. The hundred's counted breaths also make it a numbers game.

Sources 4, 16

Legs-overhead and rolling moves

The roll-over, jack knife, control balance and rolling like a ball. Yoga experts named inversions as unsuitable in anorexia, head-down positions can bring on dizziness with low blood pressure, and with low bone density, NICE advises avoiding activities that make fractures more likely.

Sources 16, 20, 6

Jumping and the reformer jump board

NICE advises people with anorexia and osteoporosis "to avoid high-impact physical activities and activities that significantly increase the chance of falls or fractures".

Source 6

Hot Pilates

MEED checks temperature and hydration, and exercise is riskier after purging or with low intake. Keep warm with layers and a blanket in rest poses, and no hot rooms (our suggestion).

Sources 20, 4

Breath holding and fast breathing

Yoga experts named "breath-holding after inhalation" as unsuitable in anorexia. Breathe easily throughout.

Source 16

Intense, burn or sculpt classes, mirrors, counting and tracking

Women in recovery found classes that stress appearance, numbers and "pushing through pain and fatigue, and ignoring one's bodily signals" unhelpful, and Beat suggests removing trackers and step counters.

Sources 17, 8

You can't tell by lookingStrong evidence

MEED says the drive to exercise "can override their lack of nutritional reserve, so that they appear very energetic right up to a physical collapse". Bulimia can bring dangerous blood salt problems "even when at a normal weight or overweight".

Source 4

The heartStrong evidence

MEED: "It is likely that excessive exercise adds to cardiovascular risk in vulnerable individuals." A slow heartbeat is common and can persist whatever your weight, and the NHS lists an irregular heartbeat and low blood pressure among anorexia's complications. Your team checks these before agreeing exercise.

Sources 4, 20, 7

PurgingStrong evidence

"Purging (vomiting and laxative use) contributes to critical electrolyte disturbances and water loss, which are both exacerbated by exercise." Don't exercise after purging, and tell your team (our suggestion).

Source 20

BonesStrong evidence

With anorexia and osteoporosis, NICE advises avoiding high-impact activities and those that make falls or fractures more likely. In Pilates, that means no jumping, no rolling or deep forward bending, smooth twists, and balance work beside a wall (our suggestion).

Source 6

Dizziness on standing

Low blood pressure on standing is a reason to change exercise until it settles. Rise slowly, sit for a moment before you stand, and stay seated if your team says so (our suggestion).

Sources 20, 10

What women in recovery found helpfulEmerging evidence

Ten women in recovery who use fitness centres found it helpful "when exercise was framed around movement, having fun, building confidence, and honoring limits".

Source 17

What experts advise for yoga, applied to PilatesEmerging evidence

Clinicians and yoga teachers agreed on gentle classes "not within a gym setting", no mirrors, "Neutral, nonjudgmental language when describing the body", a focus on what the body can do rather than how it looks, and medical clearance from your doctor. Applying their advice to Pilates is our reading; it hasn't been tested.

Source 16

Beat's practical steps

"Set an alarm for rests and finish", "Avoid solitary exercise/activity", "Remove Smart watch trackers/Turn off or delete exercise apps/step counters", and "Mix the types of movement within the session (e.g. integrate gentler, slower movement options)."

Source 8

Choosing a class

One-to-one or small classes outside a gym, with a teacher who knows about your recovery, seated and standing options and no talk about appearance, suit early recovery best (our suggestion).

Sources 16, 17

You'll meet this

In a survey of 837 Norwegian group fitness instructors, 49% were concerned about disordered eating in at least one member, and in Switzerland about 75% of fitness centre staff had suspected a client of an eating disorder or excessive exercise. In Australia, most fitness professionals didn't know the industry's guidance.

Sources 45, 46, 47

Your role

Australian fitness industry guidance says instructors "are not therapists and are not expected to provide counselling or treatment". Their role is "to identify problems as they develop and to encourage the client to seek appropriate supportive, medical and psychological help", speaking privately and "in an open and non-judgemental manner".

Sources 48, 47

What to say

Speak to them privately and kindly, without comments on their body or food, and encourage them to see a GP or contact Beat. Adapt their classes only with their team's advice (our suggestion).

Sources 48, 3

You can't tell by looking

Training helped coaches and instructors understand that eating disorders aren't "recognizable just by looking at a person", though that study had no comparison group.

Sources 49, 4

No Pilates body's guidance found

We found no eating disorder guidance from any Pilates body. The Pilates Association Australia's scope of practice says only "Collaborate with medical or allied health professionals and refer where appropriate."

Sources 23, 50

Call 999 or go to A&E

Call 999 (911 in the US) or go to A&E if:

• Someone's life is at risk: for example, they have seriously harmed themselves or taken an overdose, or they can't keep themselves safe.
• Chest pain or discomfort comes on suddenly and doesn't go away, spreads to the arms, neck, jaw, stomach or back, or comes with feeling sweaty, sick, light-headed or short of breath.
• Someone isn't responding normally or is unconscious. Very low blood sugar is one possible cause, and MEED notes that driven exercise can bring it on.

Sources 1, 51, 52, 4

Go to A&E or contact the eating disorder team straight away

For fainting when standing up, being unable to climb stairs, suddenly refusing all food or drink, a stomach bug with vomiting or diarrhoea, talk of ending their life, or struggling to get up from a squat without using the arms. If someone needs urgent medical help and you're not sure where to go, the NHS says call 111 or use 111 online.

Source 4

Urgent mental health help

Our suggestion, in the NHS's words: "A mental health emergency should be taken as seriously as a physical one. You will not be wasting anyone's time."

• Call 999 or go to A&E (accident and emergency) now if someone's life is at risk, for example they have seriously injured themselves or taken an overdose, or if you do not feel you can keep yourself or someone else safe.
• For urgent help, get help from 111 online or call 111 and select the mental health option, or ask for an urgent GP appointment.
• Call 116 123 to talk to Samaritans. If you're under 19, you can also call 0800 1111 to talk to Childline.
• Text SHOUT to 85258.

Sources 1, 2

See a GP as soon as you can

If you think you, or someone you care about, may have an eating disorder. Signs that involve exercise or the body include:

• Exercising too much, or in secret, or feeling unable to stop.
• Feeling cold, tired or dizzy.
• Pains, tingling or numbness in the arms and legs (poor circulation).
• Feeling your heart racing, fainting or feeling faint.
• Not getting your period, or other delayed signs of puberty.
• Bone pain, or broken bones after minor falls.

Source 5

Before any Pilates, check with your team

If you've recently had heart palpitations, chest pain, dizziness, fainting or light-headedness, or you're purging.

Source 8

Breathlessness

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.

Source 53

Stop the session if

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.

Source 54

Before you start

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.

Breathe out as you lift, and don't hold your breath.

Source 54

"Pilates can treat an eating disorder"Strong evidence

NICE says not to offer physical therapies as treatment, exercise hasn't been shown to improve symptoms, and the only Pilates study found no significant change in eating disorder scores.

Sources 6, 13, 11

"Any exercise is healthy in recovery"Strong evidence

NICE advises people who are exercising excessively to stop, Beat says general exercise guidance "can be detrimental" with an eating disorder, and MEED warns that people can seem energetic right up to a collapse.

Sources 6, 8, 4

"Pilates burns energy, so it helps recovery"Strong evidence

Recovery isn't about burning energy: "Remember, the goal is not to lose weight." Exercise done to make up for eating is a sign of the illness, not a help.

Sources 8, 6, 5

"Pilates is gentle, so it can't be compulsive"Emerging evidence

Compulsive exercise includes restlessness and a big increase in daily movement, not only hard exercise, and held postures with tensed muscles can be hidden exercise (our reading of MEED for Pilates).

Sources 15, 4

"If you look well, you're well enough for a class"Strong evidence

MEED: people with eating disorders "can appear well and have normal blood tests, even if they are near to death". You can't tell by looking.

Sources 4, 49

"Pilates improves body image"Mixed evidence

Mind-body exercise wasn't clearly better than usual care for body image in the newest review, which had no Pilates trial, and classes that focus on appearance can make things worse.

Sources 33, 17

"People who do yoga or Pilates don't get eating disorders"Emerging evidence

In one survey of 2,287 young adults, women who did yoga or Pilates had disordered eating as often as other women, and men who did reported more extreme weight-control behaviours. It was one survey from over 15 years ago, so it can't show cause.

Source 55

"Stopping exercise means you'll relapse"Mixed evidence

SEES-2 says stopping exercise is linked with relapse, but the study it cites found that excessive exercise straight after leaving hospital predicted relapse. Beat and the Royal College of Psychiatrists both say a pause is OK.

Sources 10, 40, 8, 9