Pilates guide
Most people have their gallbladder removed by keyhole surgery and go home the same day, and gentle Pilates-style exercises (breathing, a tummy draw-in and knee rolls) start the day after. A full Pilates class comes back in stages: knees-bent, side-lying and all-fours moves from about 2 weeks once your cuts have healed, and curl-ups, planks and roll-ups from about 4 weeks after keyhole surgery, later after open surgery. Those timings are our suggestion: no study has tested Pilates after gallbladder removal, advice from surgeons ranges from 2 to 6 weeks for heavy lifting, and your surgical team's advice comes first.
This guide covers the stages, why curl-ups and roll-ups come last, lying face down over fresh cuts, shoulder-tip pain and bloating in class, the reformer, hernias at the keyhole cuts, Pilates while you wait for surgery, other keyhole tummy operations, and the warning signs after the operation. It ends with a free 25-minute class that takes you back towards a normal beginner class.
Breathing, a gentle tummy draw-in, pelvic tilts and knee rolls are part of NHS physiotherapy advice from the day after tummy surgery, and the NHS says start light activity and build up gradually. Our exercise after gallbladder removal guide covers the first 2 weeks day by day.
Our suggestion: knees-bent, side-lying and all-fours moves from about 2 weeks once the cuts have healed, then curl-ups, planks and roll-ups from about 4 weeks. Advice varies from light exercise at about a week to no heavy lifting for 4 to 6 weeks, so ask your team, and take longer after open surgery.
Our searches found none. People recover faster than old advice assumed: in 200 people told to take 2 days off, the median return to their usual recreation was 2 days, and clear, earlier advice sped recovery without more complications in a Dutch trial of 344 people.
In 18 healthy women who already did Pilates, most moves raised tummy pressure no more than getting up from a chair, something you do many times a day after an operation. Roll-ups kept it up longest, so they come last. It hasn't been tested in men or in fresh scars.
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In large studies, 0.2% to 2.1% of people needed a repair, mostly at the belly-button cut. See a GP about a bulge near a scar.
Severe or worsening pain, a high temperature, pus, swelling or redness at a wound, yellow skin or eyes, or a painful, swollen leg need an urgent GP appointment or NHS 111; a swollen leg with breathlessness or chest pain needs 999. The full lists are below.
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"You can live without a gallbladder and continue to eat a normal, healthy diet after it's been removed." It's usually removed because gallstones are causing problems such as frequent tummy pain.
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The National Institute for Health and Care Excellence (NICE) recommends offering keyhole (laparoscopic) surgery as a day case for planned operations, and about 2 in 3 planned operations in England are day cases. Keyhole surgery uses 3 or 4 small cuts, and full recovery typically takes around 10 days; open surgery uses a larger cut and typically takes 6 weeks. In a Cochrane review, keyhole surgery shortened recovery by about 3 weeks.
Our exercise after gallbladder removal guide puts the keyhole cuts near the belly button and on the right of the tummy. That's why lying on your front, and on your right side, can be uncomfortable at first.
The NHS says "start doing some light activity but build up gradually and avoid strenuous exercise". You may be able to go back to work 1 to 2 weeks after the operation, later with a job that involves heavy lifting.
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Pain in the tip of your shoulder from the gas used in keyhole surgery is common for a few days. The NHS says feeling sick, indigestion, tummy pain or diarrhoea usually improve soon after the operation. Across 17 studies, about 1 in 6 people had diarrhoea afterwards, more with alcohol and a diet that isn't low in fat.
An NHS physiotherapy booklet for major tummy surgery says "We strongly advise you to avoid exercises like sit ups" while the tummy wall heals, lift nothing heavier than 2 to 3 kg at first, and build up to walking 30 minutes a day by 2 to 3 months. Then, "To progress your core stability exercises you could attend a Yoga or Pilates group".
Source 1
Our suggestion, built from the NHS physiotherapy booklet for tummy surgery, the Royal College of Surgeons' recovery guide, the NHS, a German review and the Pilates pressure study. Guidance ranges from light exercise at about a week to no heavy lifting for 4 to 6 weeks, no trial has tested these stages, and your surgical team's advice comes first.
See the movement on the 3D figure: Lateral breathing (Pilates breathing)
No one has tested Pilates after gallbladder removal. The evidence below is about recovery, lifting advice, tummy pressure and hernias at the cuts.
Our searches of PubMed, Europe PMC and ClinicalTrials.gov in November 2026 found none. The nearest are small nursing trials: in 66 people, deep breathing and breathing exercises borrowed from yoga eased shoulder pain in the first 24 hours, and in another trial breathing and coughing exercises eased shoulder pain at 12 hours. Both were single-centre and unblinded.
In 200 Danish people advised to take 2 days off, the median return to usual recreation was 2 days and to work 6 days; pain, tiredness and expectations drove longer recoveries. In 24 people, activity, tiredness and pain were back to normal by day 2. In a Dutch trial of 344 people having keyhole operations including gallbladder removal, clear, personalised recovery advice brought the median return to normal activities from 26 days down to 21, with no more complications.
A German review of 16 low-quality studies found no evidence for any particular limit, and 78% of 386 German hospitals based their advice on experience. The Royal College of Surgeons allows walking, swimming, cycling and light exercise from about a week if the wound is comfortable, while one NHS trust's 2024 leaflet says "Avoid heavy lifting for four to six weeks". A Dutch expert panel suggested lifting 5 kg from 2 to 4 days and 15 kg from 1 to 2 weeks.
The ERAS Society's guideline for abdominal surgery recommends getting up for 30 minutes on the day of surgery and for 6 hours a day after that (a strong recommendation, moderate evidence). A review concluded that bed rest is harmful, though studies of early-mobilisation programmes were few and poor.
In one US laboratory study of 18 healthy women who already did Pilates, most mat and reformer moves raised tummy pressure no more than getting up from a chair, and roll-ups were the highest. The authors listed lower-pressure moves for after surgery, such as bridging, lifting one knee to tabletop, the chest lift, side kicks, all fours and reformer footwork. The measure was indirect, and the study hasn't been repeated in men or after surgery.
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In large studies, 0.2% of 2,930 people, about 1% of 1,172 people followed for about 5 years and 2.1% of 1,756 people needed a repair; most hernias were at the belly-button cut. When 241 people were examined and scanned about 4 years later, 25.9% had one there, many without symptoms. Obesity, diabetes, a wound infection and a cut that had to be enlarged raise the risk. None of these studies looked at exercise as a cause.
A review found no clinical study linking activity after abdominal surgery to a hernia at the scar, and a German review noted that hernias were more common in people who avoided exertion for longer than 8 weeks. Both rest on weak evidence, so following your team's lifting advice for the first weeks still makes sense.
In 200 Swedish people, those who were regularly active before gallbladder removal were more likely to be back at work within 3 weeks. It's an observational study, so it can't show the activity caused the quicker recovery.
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In a trial of 66 people after keyhole gallbladder removal, a tummy binder made no difference to pain, walking or recovery, and people were more comfortable without one.
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From our exercise after gallbladder removal guide, which takes its doses from an NHS physiotherapy booklet: lateral breathing, 5 deep breaths 3 to 4 times an hour at first; ankle circles, 30 seconds each foot every hour while you're resting a lot; then, from the day after, a gentle tummy draw-in, pelvic tilts (no bridge yet), small knee rolls and pelvic floor squeezes, 3 to 5 of each held 5 to 10 seconds, twice a day. Walk from about day 3, 5 to 10 minutes at first (the Royal College of Surgeons' recovery guide).
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoAnkle circlesBeginner · No equipment
3D demoSide-lying tummy draw-inBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoHip windshield wipersBeginner · No equipment
3D demoPelvic floor exercise (Kegel)Beginner · No equipment
3D demoTreadmill walkingBeginner · Cardio machineHeel slide: "10 slow repetitions each side, once or twice a day" (the move page's dose). Knee fold and bent-knee fall-out: "2 sets of 5 to 10 each side, every other day" (the move page's dose). Pelvic tilt into bridge: 6 to 8 small bridges (our clinical Pilates routine's dose). Clamshell: about 1 minute each side (our clinical Pilates routine's dose). Side kick: "8 to 10 each side" (the move page's dose); lie on your left side first if the right-side cuts are sore. Open book: "8 to 10 slow openings each side" (the move page's dose), only as far as is comfortable. Cat-cow: "8 waves, slower than feels natural" (the move page's dose). Bird dog one limb: 5 each arm and leg, and sit to stand: 8 to 10 (our editorial starting points). Wall side leg lift: "10 to 12 each side" (the move page's dose).
3D demoSupine heel slideBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoBent-knee fall-outBeginner · No equipment3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSide-lying open bookBeginner · No equipment
3D demoCat-cowBeginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoSit to stand from a chairBeginner · A bench or box
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wallWhen stage 2 is easy and nothing bulges at your belly-button scar; later after open surgery. Dead bug heel taps: 5 to 8 each side, head down, and knee plank: 3 holds of 10 to 20 seconds (our stoma core class's doses). Chest lift: "8 to 10 reps" (the move page's dose); start with 5. Hundred: "50 beats to start, building to 100" (the move page's dose), head down at first. Single-leg stretch: "6 to 10 each side" (the move page's dose), with the long leg higher if your tummy domes. Roll-ups come last.
Our suggestions, from the NHS physiotherapy booklet and the Pilates pressure study. No study has tested them after gallbladder removal.
Leave the curl-up family to the last stage. The NHS physiotherapy booklet strongly advises against sit-ups while the tummy wall heals after major surgery, and the roll-up kept tummy pressure up longest of 22 Pilates moves.
Wait until the cuts have healed and it's comfortable, usually about 2 weeks, before the swan, swimming or other face-down moves. A folded towel under your hips helps at first.
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Rolling like a ball, the seal, the open-leg rocker and the roll-over press on your tummy and load it at the end of the movement. Leave them until the curl-ups feel easy.
Small knee rolls on your back are fine from the day after, as the NHS booklet shows. Leave the criss-cross and the saw until the last stage.
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Breathe out as you lift, curl or press, and hug a cushion over your tummy if you need to cough or sneeze in the first weeks (our exercise after gallbladder removal guide).
Footwork, lying arm work and side-lying work on light springs were among the lowest-pressure moves and suit the 2-week stage. The long stretch, the abdominal series and heavy springs suit the last stage.
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It's referred pain from the gas used in keyhole surgery and usually settles within days. Moving about helps, and breathing exercises eased it in small trials in the first day or so.
Keep classes away from big or fatty meals and know where the toilet is (our suggestion). If diarrhoea, tummy pain or indigestion carry on after the operation, tell your GP or care team.
Ease off if a scar pulls sharply, or if a bulge appears when you curl, plank or strain, and get it checked (see the warning signs).
Tell your teacher the date and type of your operation. The UK pelvic health physiotherapists' Pilates booklet asks women who've had recent tummy surgery to wait until they've had a post-operative check and been told it's safe to start exercising.
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The NHS physiotherapy booklet suggests about 30 minutes of exercise a day before a tummy operation, and people who were active before gallbladder surgery were back at work sooner. Pilates can be part of that.
Pilates won't treat gallstones: the only report of yoga for gallbladder inflammation is a single case. Symptomatic gallstones are treated with surgery. Stop and get help for the pain described in the warning signs below.
The stages on this page suit most planned keyhole tummy operations, but some have their own guides: a hernia repair (our Pilates with a hernia guide), a caesarean birth (Pilates after having a baby), keyhole surgery for endometriosis (Pilates for endometriosis), a hysterectomy and appendix removal (our exercise guides). Your own surgical team's advice comes first.
Start with our 15-minute routine for the first 2 weeks. Our return class then takes you through three stages, with a stop point after each. No trial has tested it: its order and doses are our editorial choice, from an NHS physiotherapy booklet, the Royal College of Surgeons' recovery guide and the Pilates pressure study. The clinical Pilates routine suits the 2-week stage; after open surgery, the bowel surgery routine uses the same NHS doses with a second level, and the stoma levels 3 and 4 class is the next step (skip their stoma tips).
A gentle 15-minute routine for the first 2 weeks after keyhole gallbladder or appendix removal: breathing, gentle tummy exercises, chair and standing moves and a walk.
15 minBeginner12 movesA bench or box, Something with weightA 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 movesA bench or box, A wallA 15-minute routine of the exercises NHS physiotherapy Pilates classes send home: bridge, knee folds, leg slides, clam, side kick and side openings.
15 minBeginner10 movesNo equipmentA 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 movesA bench or box, A 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 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 steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallThe walking plan builds back towards 150 minutes a week.
The lines after the operation are from our exercise after gallbladder removal guide, word for word, from the NHS complications page; the lines while you wait for surgery are the NHS gallstones page's words; the heart lines are 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.
The NHS says get help if:
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Call 999 or go to accident and emergency (A&E) if you have pain and swelling in your leg and you're having difficulty breathing or chest pains: this could be a blood clot in your lungs. Call 999 for chest pain that feels tight or spreads to your arms, neck or jaw. Don't drive yourself to A&E.
If feeling sick, indigestion, tummy pain or diarrhoea carry on after the operation.
Source 13
A hernia at a cut feels like a soft lump or bulge near a scar, often easier to see when you cough or strain. See a GP if you notice one. Our hernia guide lists the signs that need 999, such as very bad tummy pain that doesn't go away, or not being able to poo or fart.
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The Royal College of Surgeons says that if you feel pain as you build up, you have probably just overdone it a little: ease back, then build up gradually again. Stop if a wound pulls sharply or a bulge appears when you strain, and get advice if it doesn't settle.
Source 3
The NHS says ask for an urgent GP appointment or get help from NHS 111 if "you have pain in your tummy that lasts longer than 30 minutes", and call 999 or go to A&E if "you have sudden, severe pain in your tummy", "you have pain that spreads from your tummy to your back, and are being sick", "your temperature is very high, or you feel hot, cold or shivery" or "your skin or the white part of your eyes looks yellow".
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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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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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Full recovery typically takes around 10 days after keyhole surgery, the NHS says start light activity and build up, and people told to expect a quick recovery were back to their usual recreation within days. Six weeks is the timescale after open surgery.
Bed rest is harmful after an operation, and guidelines recommend getting up on the day of surgery.
Most beginner Pilates moves raised tummy pressure no more than getting up from a chair in one small study, and an NHS physiotherapy booklet suggests a Pilates or yoga group to build core strength after major surgery. Curl-ups, roll-ups and planks come later.
Hernias at the cuts are uncommon, and no clinical study links activity after surgery to them, though the evidence is weak. Follow your team's lifting advice for the first weeks.
No study shows it; the only report is a single case. Gallstones that cause symptoms are treated with keyhole surgery.
Mat Pilates is Pilates. Reformer footwork and lying arm work were among the lowest-pressure moves, so either suits the return (our reading).
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Gentle breathing, a tummy draw-in and knee rolls start the day after keyhole surgery. Our suggestion is knees-bent, side-lying and all-fours Pilates from about 2 weeks once your cuts have healed, and curl-ups, planks and roll-ups from about 4 weeks, later after open surgery. Advice varies, so your surgical team's comes first.
Yes, in stages: footwork, lying arm work and side-lying work on light springs first, then the abdominal series and the long stretch later. Those first moves were among the lowest-pressure in a study of 22 Pilates moves.
Leave curl-ups, the hundred and roll-ups until gentler work is easy and nothing bulges at your belly-button scar: from about 4 weeks after keyhole surgery is our suggestion. An NHS physiotherapy booklet strongly advises against sit-ups while the tummy wall heals after major surgery.
Hernias at the keyhole cuts are uncommon, and we found no study linking Pilates or exercise to them. Build up gradually, breathe out on the effort and see a GP if you notice a bulge near a scar.
It's referred pain from the gas used in keyhole surgery, and it usually settles within a few days. Moving about helps, and breathing exercises eased it in small trials.
Wait until your cuts have healed and it feels comfortable, usually about 2 weeks. Then try a small swan with a folded towel under your hips.
The date and type of your operation, keyhole or open, and anything your team told you to avoid. A teacher may ask for your team's go-ahead first, as the UK pelvic health physiotherapists' Pilates booklet advises after recent tummy surgery.
It won't treat it, but gentle upright and side-lying work and walking can ease bloating, and keeping classes away from big meals helps. If diarrhoea or tummy pain carries on, see your GP.
Usually, yes, and being active before surgery went with a quicker return to work in one study. Ask for an urgent GP appointment or call NHS 111 for tummy pain lasting longer than 30 minutes, and call 999 for sudden, severe tummy pain, a very high temperature, or yellow skin or eyes.
No study shows it does. Gallstones that cause symptoms are treated with surgery, and Pilates is for staying active around it.
Ask for an urgent GP appointment or call NHS 111 for severe or worsening pain, a high temperature, pus, or pain, swelling or redness at a wound, yellow skin or eyes, or a painful, swollen leg. Call 999 for a painful, swollen leg with difficulty breathing or chest pain.
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.
