Pilates guide
Exercise is the best-supported treatment for fibromyalgia, and Pilates is one good way to do it. In trials, Pilates eased pain a little and made fibromyalgia less of a burden on daily life compared with usual care. Against other exercise, it did no better, so the best choice is one you enjoy and can keep doing.
The key is to start lower than you think and build up slowly, pacing yourself so a good day doesn't turn into a flare. This guide covers what the trials show, how to start and pace yourself, what to do in a flare-up, the advice of the National Institute for Health and Care Excellence (NICE) and the new symptoms that need a GP, with a gentle 20-minute class. It isn't advice for myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS).
NICE offers supervised group exercise for long-lasting pain without another cause, which includes fibromyalgia, and names no type. European guidelines make exercise their only strong recommendation, and the NHS lists it as one of the 3 main treatments.
Across 6 trials (265 people), pain fell by about 0.7 points out of 10, and the impact of fibromyalgia on daily life by about 7 points out of 100.
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In the newest review (2026, read as an abstract), Pilates did no better than other exercise, at very low to low certainty, and trials against aerobic and water exercise found similar gains.
Trials began with 1 set of 8 of each move, twice a week, and built up over 3 months. Start smaller still if you need to.
Feeling a bit worse at first is common and isn't damage. Balance activity and rest so good days don't turn into flares.
If activity is followed by a delayed crash that takes days to recover from, see a GP: NICE advises against graded exercise for ME/CFS.
"A long-term condition that causes pain all over the body", the NHS says, with increased sensitivity to pain, stiffness, poor sleep and tiredness, problems with memory and concentration ("fibro-fog"), headaches and irritable bowel syndrome. It's more common in women, usually starts between 25 and 55, and may affect nearly 1 in 20 people to some degree. NICE counts it as chronic primary pain: long-lasting pain that no other condition explains.
Symptoms can get better or worse with stress, changes in the weather and how active you are. NICE describes a flare-up as "a sudden, temporary worsening of symptoms", whose cause may not be found.
In most people, exercise briefly dampens pain. In a lab study of women with fibromyalgia, that pain-dampening response didn't switch on during muscle contractions, which is one reason to start gently.
Pilates is low-impact, can be done lying, sitting or standing, can be made very small and slow, and mixes strength, flexibility and breathing, which suits the NHS's suggestion of aerobic or strengthening exercise plus relaxation every day. Clinical Pilates, taught by physiotherapists, was the form used in several trials. It's one choice among many: NICE doesn't name a type of exercise.
Across 6 trials (265 people), read in full, Pilates reduced pain by about 0.7 points on a 0 to 10 scale, and the Fibromyalgia Impact Questionnaire (FIQ, a 0 to 100 score of how much fibromyalgia affects daily life) by about 7 points, compared mostly with usual care or no exercise. The trials were small and of mixed quality, and none reported harms. In a 6-month trial of live online Pilates-based exercise 3 times a week (68 adults, read in full), the revised FIQ improved by about 12 points against usual care, with better sleep and mood; online clinical Pilates also beat the same exercises given on paper.
In the newest review (2026, read as an abstract), 7 trials since 2020 found that Pilates did no better than other active exercise for pain or daily impact, at very low to low certainty. Trials against aerobic exercise (98 people and 46 women) and water aerobics (42 women) found similar gains, and in a 2024 review, Pilates wasn't clearly better for pain than aerobic or mind-body exercise.
Network analyses of 50 to 59 trials ranked Pilates among the best types of exercise in the short term, with water exercise, strength training and aerobic plus flexibility training, at low or very low certainty. In the longer term, dance, mixed exercise and strength training ranked best.
Online clinical Pilates eased tiredness more than the same exercises on paper, and the 6-month online programme improved sleep, depression and stress but not anxiety. Across 21 trials of mind-body exercise, sleep and depression improved, and experts rate mind-body exercise a core treatment for pain, tiredness and sleep problems.
Cochrane reviews found that aerobic exercise probably improves quality of life and may ease pain a little, mixed exercise probably improves physical function and tiredness, and strength training may improve function and pain, at low to moderate certainty. Programmes that met the American College of Sports Medicine's exercise guidance did better.
In the first Pilates trial, most gains had faded 12 weeks after classes ended, and for aerobic exercise, long-term benefits lasted for pain and function but not for quality of life. Group programmes lose about 1 in 5 people. NICE encourages staying active for the longer term.
In a trial of 226 people, tai chi eased fibromyalgia symptoms more than aerobic exercise at 24 weeks, and 24 weeks of tai chi beat 12.
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"Offer a supervised group exercise programme to people aged 16 years and over to manage chronic primary pain. Take people's specific needs, preferences and abilities into account." The committee didn't name a type of exercise. Most of its evidence was supervised group exercise in women with fibromyalgia or long-lasting neck pain; exercise was good value, with no harms seen except more people dropping out.
Exercise was the only "strong for" recommendation from EULAR (the European Alliance of Associations for Rheumatology), with aerobic and strengthening exercise both fine, on land or in water. Meditative movement such as tai chi and yoga got a weaker recommendation, and Pilates isn't mentioned.
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An international panel of 17 experts rated aerobic exercise, education, sleep habits and CBT (cognitive behavioural therapy) core treatments, and mind-body exercise core for pain, tiredness and sleep. The 2026 Brazilian guideline recommends aerobic and strength exercise and doesn't mention Pilates.
The NHS lists exercise, talking therapies and medicines as the 3 main treatments, says regular exercise "has been shown to help reduce pain and improve overall quality of life", and says the type "should be something you enjoy and can continue doing long-term". Its self-help advice includes relaxing every day.
A 12-week mat programme started with 1 set of 8 of each move twice a week, built to 2 sets of 10 in the second month and 3 sets of 8 in the third. Another trial ran 60-minute sessions (10 minutes of warm-up, 40 of Pilates and 10 of cool-down) with 8 to 10 repetitions, and taught breathing first. Others moved people on only when 10 repetitions felt controlled, ended with relaxation, and let symptoms guide progress.
EULAR summarises the trials as aerobic exercise for at least 20 minutes a day (or 2 bouts of 10) on 2 to 3 days a week, and strength work with at least 8 repetitions, 2 to 3 times a week, in programmes of 2.5 to 24 weeks.
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Start smaller than the trials if you need to: 15 to 20 minutes, the easiest versions, and stop while you still feel you could do more. Add a few minutes or a second set every week or two if you haven't had a flare (our editorial starting point).
NICE offers supervised group programmes. One-to-one and group clinical Pilates both helped, live online classes worked over 6 months, and online classes did better than the same exercises on paper.
"Pacing means balancing activity and rest so you don't overdo it on good days or feel worse after doing too much", Arthritis UK says. Exercise improves tiredness and pain control, "but it's important to pace yourself".
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"On a good day it is important to pace yourself; overdoing it may simply make matters worse. Rest is also important. Listen to your body when it tells you to slow down", Fibromyalgia Action UK says.
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Gradually increasing how much exercise you do can improve your symptoms, Arthritis UK says, and fibromyalgia "doesn't seem to cause long-term damage to your body". The trial programmes built up over 3 months.
"Although patients may initially notice a deterioration in symptoms, exercise is generally considered safe, especially when practised under supervision", EULAR says. One trial warned people to expect "a tolerable increase in pain and fatigue in the short term", and in other trials, some people had more pain, soreness or tiredness during or after exercise.
NICE asks clinicians to reassess you, accept that a cause may not be found, review your plan and look into any new symptoms. Drop back to a shorter, easier session, or just breathing and gentle movement, for a few days, then build up again slowly (our suggestion, in line with pacing advice). Our gentle class has a stop point for bad days.
Muscle soreness a day or two after new or harder exercise happens to everyone and fades within days; a flare is a wider worsening of your usual symptoms. Our guide to sore muscles explains the difference.
NICE advises against exercise programmes with fixed increases (graded exercise therapy) for ME/CFS, and notes that the crash after activity is often delayed by hours or days; the NHS says graded exercise therapy is not recommended for it. If that pattern sounds familiar, see a GP; our ME/CFS guide covers pacing for it.
Start with 1 set of 8 of each, as the trial programme did in its first month, with your head resting for the curl-up moves; build to 2 sets of 10 over the following weeks if you tolerate it.
3D demoSlow breathing (6 breaths a minute)Beginner · No equipment
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoBent-knee fall-outBeginner · No equipment
3D demoHip windshield wipersBeginner · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoSingle-leg stretch (Pilates one leg stretch)Intermediate · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoSaw (Pilates)Intermediate · No equipment
3D demoHundred (Pilates)Intermediate · No equipmentEuropean guidelines summarise strength work as at least 8 repetitions, 2 to 3 times a week: start with 1 set of 8, and a light band for the row.
Finish with gentle rotation and at least 5 minutes of lying still; two of the trial programmes ended with relaxation.
Leave out the roll-up, the teaser, rolling like a ball, the open-leg rocker and control balance at first: they need momentum or put weight on your neck. Skip the kneeling side kick if kneeling or leaning on a wrist hurts, and keep holds short (our suggestion, in line with each move's caution).
One case report described nerve pain in the pelvis in a woman with fibromyalgia after intense Pilates. Build up slowly rather than pushing through pain.
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Start with our gentle 20-minute class, which has a stop point for bad days; the flare-up routine suits the worst days, and the arthritis and somatic classes are other gentle options.
A gentle 20-minute Pilates class for fibromyalgia, built on the trial programmes: 8 of each move, a stop point for bad days, and rest to finish.
20 minBeginner13 movesNo equipmentA 10-minute routine for a pain flare-up: slow breathing, small gentle moves lying and sitting, a short stroll if you can, then rest. Repeat later in the day.
10 minBeginner10 movesA band, A bench or boxA gentle 25-minute Pilates class for arthritis: lying, side-lying, chair and standing moves, with no kneeling or weight on your hands, and flare-day options.
25 minBeginner16 movesA bench or box, Something with weightA slow, 20-minute Pilates class with time to notice your breath and how each move feels. Every move is optional and you can pause or stop at any point.
20 minBeginner12 movesNo equipmentA 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 movesA bench or box, Something with weightA 10-minute session for low-energy days: marching, sit-to-stands, wall push-ups, step-ups and bridges, then a short walk. Doing a little counts.
10 minBeginner7 movesA bench or box, A wallA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepFor the aerobic side, built up slowly: repeat a week, or drop back, if a step brings on a flare.
NICE asks clinicians to "consider investigating and managing any new symptoms", and the NHS notes that swollen joints can point to arthritis rather than fibromyalgia. Get checked for these (the last is our advice, in line with NICE):
For sudden weakness or numbness on one side of your body, a drooping face, or slurred or confused speech: these are signs of a stroke. In the US, call 911.
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If activity is regularly followed by a worsening out of proportion to what you did, coming hours or days later and taking days to recover from, see a GP: it can be a sign of ME/CFS.
If low mood, anxiety or poor sleep are getting on top of you, see a GP: talking therapies are one of the NHS's 3 main treatments. If you need help now, call 111 and select the mental health option, or call Samaritans free on 116 123, any time; call 999 if a life is at risk. In the US, call or text 988.
Exercise is the main recommended treatment. You may feel a bit worse at first, but exercise is generally safe, and fibromyalgia doesn't seem to cause long-term damage to your body.
In the newest review (2026, read as an abstract), Pilates did no better than other exercise, and network analyses ranked it high only in the short term and at low certainty.
The trials are small, the certainty is low to very low, and few recorded harms carefully. Pilates helps about as much as other exercise, which is still worth having.
In a trial of 28 women, home mat Pilates and reformer Pilates improved symptoms about equally. Start with easy mat moves.
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NICE encourages staying active, and pacing means balancing activity and rest, not stopping. Long rest tends to make it harder to start again (our view).
NICE advises against graded exercise therapy for ME/CFS, which is a different condition. For fibromyalgia, NICE offers supervised group exercise, and Arthritis UK says building up gradually can improve symptoms.
It can help. Across 6 trials, Pilates eased pain by about 0.7 points out of 10 and reduced the impact on daily life, compared with usual care or no exercise. It works about as well as other exercise, so it's a good choice if you enjoy it.
Not as far as trials show. In the newest review, Pilates did no better than other active exercise, and trials against aerobic exercise and water aerobics found similar gains, at low certainty. NICE recommends a supervised group exercise programme without naming a type.
Neither has been shown to be better. In a 2024 review, Pilates wasn't clearly better for pain than mind-body exercise such as yoga, and experts rate mind-body exercise as a core treatment for pain, tiredness and sleep. Our exercise for fibromyalgia guide covers tai chi and yoga.
You may feel more sore or tired at first, which is common and not harmful. If a session leaves you much worse the next day, you did too much: drop back to what felt manageable and build up more slowly. Serious harm hasn't been reported in trials, though few looked for it carefully.
Start smaller than you think: trials began with one set of 8 of each move, twice a week, and built up over 3 months. Choose easy moves lying down, keep sessions short at first, and stop before you're tired. Our 20-minute gentle class follows this plan.
Twice a week, as in most trials, is a good start; some trials used 3 sessions a week. Add gentle walking, cycling or swimming on other days, building up slowly.
The trials used simple mat moves: a pelvic lift, leg circles, the single-leg stretch, side kicks, the swan and the saw, starting with 8 of each. Use the easiest versions with your head resting, and skip moves that roll you onto your neck or need momentum.
Do less, not nothing. Drop back to a shorter, easier session, or just breathing and gentle movement, then build up again slowly as the flare settles. If you have new symptoms with a flare, see a GP.
It can be, but you don't need it. In a trial of 28 women, reformer Pilates and home mat Pilates improved symptoms about equally. Choose the one you can do regularly.
Yes, in trials. Live online classes 3 times a week for 6 months improved symptoms, sleep and mood, with good attendance and no harms, and online clinical Pilates did better than the same exercises on paper.
The NHS recommends exercise as one of the 3 main treatments, and says it should be something you enjoy and can keep doing. It doesn't name Pilates, and neither does NICE, which offers supervised group exercise of any type.
No. ME/CFS is a different condition, and NICE advises against graded exercise for it. If activity is followed by a delayed crash that takes days to recover from, see a GP and follow NICE's ME/CFS guidance.
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.
