Pilates guide
Pilates can be a good addition for people with heart disease, as strength and flexibility work alongside walking, cycling or your cardiac rehabilitation (rehab) exercise. It is light to moderate and doesn't count as cardio. It has only been tested in two small studies of heart patients, and nobody knows whether it lowers your risk of another heart problem.
So cardiac rehab comes first: ask for it, and start Pilates after your rehab assessment or once your cardiac team agrees. Then keep breathing, keep holds short, keep your head up, and warm up for longer than a normal class does.
This guide covers where Pilates fits after a heart attack, stent or bypass and with heart failure, what the studies show, breathing and holds, the long warm-up and seated cool-down rehab asks for, the breastbone after surgery and the arm after a pacemaker or implanted defibrillator (ICD), a 40-minute class, and the warning signs to know.
Across 107 trials, exercise-based cardiac rehab cut heart attacks by about a quarter and hospital admissions by about a third. NICE (the National Institute for Health and Care Excellence) says everyone should be offered it after a heart attack, and everyone with heart failure after an assessment. Only about 4 in 10 eligible people in England start it after a heart attack.
We found two small studies: 16 people with heart failure and 40 people after bypass surgery. No Pilates study has looked at heart attacks, hospital stays or deaths.
Most Pilates is light to moderate. The NHS and the British Heart Foundation (BHF) say it doesn't count towards your 150 minutes of aerobic activity a week.
Holding your breath while straining sends blood pressure very high. UK rehab standards say avoid sustained breath holding and long static holds, and the BHF says no planks or press-ups with heart failure.
Rehab asks for a 15-minute warm-up, a cool-down of at least 10 minutes, and floor work only once your heart rate has settled. Don't lie down straight after exercise.
After bypass or valve surgery, follow your team's breastbone rules and keep your upper arms close when you push or lift. After a pacemaker or ICD, keep that elbow below shoulder height for 4 to 6 weeks.
Coronary heart disease (narrowed heart arteries) can cause angina, chest pain on effort that settles with rest or your glyceryl trinitrate (GTN) spray, and heart attacks; it is treated with medicines, stents or bypass surgery. Heart failure means the heart doesn't pump as well as it should; the NHS lists "feeling out of breath when doing everyday activities or lying down" and "swelling in your feet, ankles, legs or tummy" among its symptoms.
A programme of supervised exercise, education and support after a heart attack, stent, bypass or valve surgery, and for heart failure. The NHS describes "weekly sessions that last 6 to 12 weeks". UK standards say it starts with a face-to-face check of your fitness before any exercise is planned. The exercise in the trials was mostly aerobic, such as cycling, walking or circuits.
Light to moderate strength, control and flexibility work, mostly lying or sitting. In healthy young women, mat and reformer sessions didn't raise heart rate or blood pressure above resting levels, and a session was about as hard as walking at 3.2 km an hour.
Lying down soon after effort and getting up quickly can make you dizzy; holds such as planks invite breath holding; legs-overhead moves put your head below your heart; and all fours, planks and push-ups put weight through your arms, which matters after breastbone surgery.
In the 2026 Cochrane review of coronary heart disease (107 trials, 26,886 people), rehab cut heart attacks by about a quarter (high certainty) and hospital admissions by about a third over 6 to 12 months, and probably reduced deaths a little. Only 17% of the people in the trials were women.
In 60 trials of people with heart failure, rehab cut hospital admissions (15.9% against 23.8%) and improved quality of life, with no clear effect on deaths. A trial of 2,331 people found a small fall in deaths or admissions once other factors were taken into account.
NICE says everyone, whatever their age, should be offered rehab with an exercise component after a heart attack, starting within 10 days of leaving hospital, and that everyone with heart failure should be offered a personalised, exercise-based programme after an assessment. European guidelines recommend it for all people with coronary disease and stable heart failure.
In England, 44.5% of people take up rehab after a heart attack or similar event, and 16.4% with heart failure. If you weren't offered it, ask your GP or cardiac team: the NHS says you don't need a referral from your cardiologist.
Start Pilates after your rehab assessment, or once your team agrees, beginning with breathing and seated moves (our suggestion, as our yoga for heart health guide says). The NHS asks anyone who has had a recent heart attack or operation to get advice before following its Pilates videos.
In 16 people with stable heart failure, everyone did 30 minutes of aerobic exercise and then 20 minutes of either mat Pilates or usual rehab exercises, for 16 weeks. Peak fitness (VO2) rose only in the Pilates group, from 20.9 to 24.8 mL/kg/min. A later review's table reports the sessions as twice a week for 60 minutes. We couldn't read the full paper, so the exercises used and any harms weren't available to us.
In 40 people (average age 66), adding Pilates techniques to hospital physiotherapy after intensive care gave better shoulder and knee movement and less loss of breathing-muscle strength by discharge. Lung volumes didn't differ, and the groups weren't allocated at random.
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We found no Pilates trial after a heart attack, in angina, atrial fibrillation (AF) or valve disease, or with a device, and none measured heart events. Reviews of mind-body exercise in heart failure rest on the one pilot trial, and four registered Pilates trials in heart patients haven't published results.
In 12 trials in healthy adults, Pilates improved fitness more than doing nothing, but only after at least 1,440 minutes in all, and not more than other exercise; the evidence was very low to low certainty. In people with health conditions, the effect wasn't clear.
Pilates lowered blood pressure by about 5/3 mmHg (millimetres of mercury, the unit of a blood pressure reading) in small trials (our Pilates for high blood pressure guide has the detail). Cholesterol fell only in trials of people with diabetes, and not in older women with high cholesterol. A 4-week study in 30 women had no comparison group.
Aerobic rehab exercise has the evidence for fewer heart events. Yoga-based rehab after a heart attack (3,959 people) improved how people rated their health but didn't show fewer heart events. Strength training is recommended alongside aerobic exercise, and Pilates is one way to do the strength part.
Most Pilates is light to moderate exercise: the Compendium of Physical Activities puts it at 1.8 to 2.8 METs (metabolic equivalents, where 1 MET is the energy you use sitting still), and a 2026 review of studies in healthy young adults at about 3 METs. That review says its results can't be applied to people in rehab.
The NHS counts Pilates as muscle-strengthening and says these exercises are "not always an aerobic activity, so you'll need to do them as well as your 150 minutes". The BHF says to combine it with 150 minutes a week of moderate activity.
MET values don't reflect effort well after a heart attack, and beta blockers slow your heart, so judge effort by how it feels: "fairly light" to "somewhat hard" (11 to 14 on the Borg scale of 6 to 20), still able to talk.
In heavy leg presses, blood pressure averaged 311/284 mmHg with the breath held against 198/175 breathing out. In 17 people with severe heart failure, holding the breath and straining changed heart and lung pressures far more than a short contraction with normal breathing. UK rehab standards say avoid breath holding, and US heart guidance says strength work is safe "with proper breathing techniques".
Rehab avoids long holds such as planks and the wall sit, which invite breath holding. With coronary heart disease, ask your cardiac team before long holds; with heart failure, leave planks and press-ups out. In Pilates, come out of any position after a few breaths (our suggestion).
Leave out the roll-over, jack knife, control balance and boomerang, which take your legs over your head. No trial has tested them in heart disease: this is a precaution, as our yoga for heart health guide leaves out the plough and shoulder stand.
The 2023 standards of the Association of Chartered Physiotherapists in Cardiovascular Rehabilitation (ACPICR), in their open version, ask for a warm-up of 15 minutes in all, building gradually, and a cool-down of at least 10 minutes. A normal Pilates class warms up for a few minutes.
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The same standards put floor work, such as relaxation and stretching, after the cool-down, once your heart rate is near resting, and advise against quick changes of position. The BHF says don't lie down straight after exercise. So do standing work first, mat work later, and roll to your side and sit for a few breaths before standing up.
Aim for Borg 11 to 14: breathing a little harder but able to talk. Stop and sit if you feel dizzy, get chest pain or palpitations.
Don't exercise on a day you feel unwell or more tired or breathless than normal, and weigh yourself regularly: the BHF says fluid can add as much as 3 kg in 1 or 2 days. Seated Pilates suits low days, and prop yourself up if lying flat makes you breathless.
The BHF says avoid lifting heavy weights, holding your breath, and "using your whole body as a weight, such as press-ups or planks".
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In 17 trials, training the breathing muscles added about 73 metres to a 6-minute walk. It's arranged through your rehab or heart failure team, not a Pilates class.
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Newer evidence supports keeping your upper arms close when you push, pull or lift, within pain-free limits ("keep your move in the tube"), rather than strict bans: in 72 people less restrictive rules worked as well, and across 12 studies they didn't increase infection or breastbone problems. As our heart surgery guide says: "Follow your own team's breastbone rules: your hospital will give you its version. Whatever the rules, keep your upper arms close when you lift, push or pull, keep your shoulders moving with unloaded arm exercises, and stop anything that hurts or makes your breastbone click. If you were given a support vest, wear it as advised."
Our suggestion: don't put weight through your arms, as in all fours, planks, push-ups or getting down to the floor on your hands, until your surgeon or rehab team says so; leave out lying face down for now; and keep twists small and pain-free. Do the standing and seated parts of our class meanwhile.
"The NHS says don't lift your elbow above shoulder height, carry heavy objects or do vigorous exercise for 4 to 6 weeks, so the leads can settle. Hospitals' advice ranges from a sling for the first 24 hours to keeping the elbow below shoulder height for 6 weeks, so your own clinic's leaflet comes first." In Pilates, reach out to the side, not overhead, on that side for now. Afterwards the BHF says most people with an ICD get back to yoga and Pilates; US heart guidance says ask before upper-body strength work.
At least 150 minutes a week of moderate aerobic activity, with strength work on 2 days (and balance and flexibility for older adults). NICE asks people after a heart attack to be active for 20 to 30 minutes a day to the point of slight breathlessness. Rehab strength work is 2 to 3 sessions a week, starting with 1 set of 8 to 10 slow repetitions with a light weight and building to 3 sets.
20 minutes of mat Pilates after 30 minutes of aerobic exercise, for 16 weeks, in people with stable heart failure.
Our editorial starting point, after your rehab assessment:
3 minutes of seated marching and 10 shoulder circles each way (within that move's page dose) are from our yoga for heart health class; 5 lateral breaths and 5 breath reaches, breathing out for longer, are the move pages' doses; 5 thoracic rotations each side, seated, are from our heart failure workout; 2 slow hip circles each leg and marching for 2 minutes, then 4 minutes building to "breathing a little harder but talking easily", are from our cardiac rehab-style workout.
3D demoSeated marchBeginner · A bench or box
3D demoShoulder rollsBeginner · No equipment
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoBreath reachBeginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoStanding hip CARsBeginner · A wall
3D demoStanding marchBeginner · No equipmentBreathe out on each effort. 8 to 10 sit-to-stands, wall push-ups and light band rows, and 8 seated knee extensions each leg, are from our heart failure workout; 5 to 8 sit-to-stands pushing on your thighs (after breastbone surgery) from our exercises after heart surgery; 10 to 15 slow calf raises from our cardiac rehab-style workout; 10 side leg lifts each side and 5 upper-back lifts held 3 to 5 seconds sit within the move pages' doses.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoSit to stand, pushing on the thighsBeginner · A bench or box
3D demoWall push-upBeginner · A wall
3D demoBand rowBeginner · A band + An anchor point
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoSlow calf raiseBeginner · A wall
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box8 slow bridges, 10 clams each side and 5 bird dogs each side are from our head-up Pilates for high blood pressure class (no bird dog after breastbone surgery until your team agrees); 5 knee folds each side from our clinical Pilates class; 5 leg circles each way, 8 side kicks each side, 3 spine twists and 3 mermaid stretches each way are the move pages' doses (the mermaid on a chair, reaching sideways on a device side).
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoSpine twist (Pilates)Beginner · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipment3 minutes of slower seated marching is from our heart failure workout; 6 seated cat-cows with your hands on your knees, 8 table slides and 2 chest stretches of 20 seconds (after breastbone surgery only if your team agrees) are from our yoga for heart health class; 5 minutes of slow breathing, sitting, with no holds, is the move page's dose. Lie down to rest only after the seated cool-down.
3D demoSeated marchBeginner · A bench or box
3D demoCat-cowBeginner · No equipment
3D demoTable slide (seated forward reach)Beginner · A bench or box
3D demoChair chest and shoulder stretchBeginner · A bench or box
3D demoSlow breathing (6 breaths a minute)Beginner · No equipment
3D demoCorpse pose (Savasana)Beginner · No equipmentThe roll-over, jack knife, control balance, boomerang, high scissors and high bicycle: leave them out (a precaution, not a trial finding).
Box and 4-7-8 breathing: leave out the holds and breathe slowly instead.
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Planks, side planks, knee hovers, leg pulls and wall sits: ask your cardiac team before long holds with coronary heart disease, and leave planks out with heart failure.
With heart failure, push-ups go to the wall. After breastbone surgery, no push-ups, planks or all-fours moves until your team says your arms can take weight.
For the first 4 to 6 weeks after a pacemaker or ICD, keep that elbow below shoulder height: reach to the side in the mermaid and breath reach, and skip overhead reaches.
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Keep roll-downs and child's pose brief and come up slowly. On a reformer, keep springs light to moderate and keep breathing. Skip hot classes (our suggestion).
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Our 40-minute class is for after your rehab assessment. The cardiac rehab-style and heart failure workouts are the aerobic base; the heart surgery and pacemaker sessions cover the first 6 weeks, when Pilates waits.
A 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 45-minute home session built like a UK cardiac rehab class: a 15-minute warm-up, 20 minutes of cardio mixed with light strength, and a 10-minute cool-down.
45 minBeginner14 movesA wall, A bench or boxA 40-minute heart failure workout you can do seated or standing: a long, gentle warm-up, cardio mixed with light strength, and a slow cool-down.
40 minBeginner13 movesA bench or box, A wallA gentle 35-minute yoga class for heart conditions: a 15-minute warm-up that builds slowly, short standing poses, a seated cool-down, breathing with no holds and rest.
35 minBeginner18 movesA bench or box, A wallA 20-minute chair Pilates workout for beginners and older adults: breathing, sitting tall, gentle spine and leg moves, and a standing finish at the chair.
20 minBeginner14 movesA bench or box, Something with weightA gentle 15-minute routine for the first 6 weeks at home after heart surgery: breathing, circulation, shoulder and posture moves, and a building walk.
15 minBeginner9 movesA bench or box, A wallGentle arm, shoulder and neck exercises for the first 6 weeks after a pacemaker or ICD, keeping your elbow below shoulder height so the leads can settle.
10 minBeginner7 movesA bench or box, A wallThe walking plan builds towards 150 minutes a week, the aerobic activity that Pilates doesn't replace.
These are the same warning signs as our exercise for heart disease guide. In the US, call 911 where this page says 999.
Call 999 (911 in the US) if:
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Don't drive yourself to A&E. Sit and rest on the floor with your knees bent and your back supported. Take a 300 mg aspirin if you have one and aren't allergic to aspirin, and use your GTN if you have angina. If someone stops responding and stops breathing, start CPR (cardiopulmonary resuscitation).
Stop what you're doing and rest. Use your GTN as prescribed, and take another dose after 5 minutes if the first doesn't help. If you still have symptoms 5 minutes after the second dose, call 999. If you don't have your GTN with you, rest, stay calm and call 999.
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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, sit down and don't exercise again that day if you feel dizzy, get chest pain or your heartbeat becomes very irregular, and tell your rehab team before your next session. With heart failure, also stop for extreme shortness of breath.
Tell your heart failure team if you notice any of these. On those days, don't exercise (our suggestion, following the BHF's advice not to exercise when you're unwell or more breathless than normal).
Stop if you get chest pain, palpitations, dizziness or light-headedness, and get urgent advice if it doesn't settle quickly with rest. Don't exercise again that day, and tell your rehab team before your next session. Also stop any movement that causes pain or clicking in your breastbone.
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One shock and you feel well: sit and rest, then contact your ICD clinic, and don't drive. Call 999 if you feel unwell afterwards, have more than one shock, or black out.
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Beta blockers slow your heartbeat and may make you feel more tired or less energetic. Use the talk test or the Borg scale rather than heart rate. If a beta blocker makes you dizzy, the NHS says not to drive, ride a bike or use machinery until the dizziness stops. Talk to your doctor if you want to change your exercise routine, and don't change your dose yourself.
Before harder exercise, such as interval training, heavy lifting, competitive sport, or sports with sudden bursts of effort such as squash. Health screening advice from the American College of Sports Medicine (read as the abstract) also asks people with heart disease to get medical advice before starting exercise they aren't used to.
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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It hasn't been tested after a heart attack, but it's light to moderate exercise. The risks to avoid are starting before your rehab assessment, holding your breath and long holds.
Rehab is what cut heart attacks and admissions in 107 trials; no Pilates trial has measured them, and even a large yoga-based rehab trial didn't show fewer heart events.
The NHS counts it as muscle-strengthening, not aerobic, and the BHF says combine it with 150 minutes of moderate activity.
Rehab includes light strength training 2 to 3 times a week. What to avoid is heavy lifting, breath holding and, with heart failure, planks and press-ups.
Breathe out on the effort. Holding your breath while straining raises blood pressure sharply.
The heart failure trial used mat Pilates, and mat and equipment Pilates improved fitness alike in healthy adults.
It can be part of a heart-healthy week as strength and flexibility work, but it isn't cardio: the NHS and the BHF say you still need 150 minutes of aerobic activity a week. Only two small studies have tested Pilates in people with heart disease, and none looked at heart attacks or hospital stays.
It hasn't been tested after a heart attack, but it's light to moderate exercise. Ask for cardiac rehab first, which NICE says should start within 10 days of leaving hospital, and start Pilates after your rehab assessment or once your team agrees. Keep breathing and keep holds short.
No. Rehab is what has been shown to cut heart attacks by about a quarter and hospital admissions by about a third; no Pilates study has measured these. Pilates can be an extra once rehab has set your safe level.
In one small trial, people with stable heart failure who did Pilates after aerobic exercise improved their fitness more than those doing usual rehab exercises. Do it as part of a rehab programme, skip planks and press-ups, and skip days when you're more breathless than usual or have suddenly gained weight.
Wait for your team's go-ahead, usually after the first weeks of recovery and your rehab assessment. Keep your upper arms close when you push or lift, and don't put weight through your arms, as in all fours or planks, until your team says so.
Yes, once the leads have settled: for the first 4 to 6 weeks the NHS says don't lift your elbow above shoulder height on that side or do vigorous exercise. After that, the BHF says most people with an ICD get back to yoga and Pilates; ask before any upper-body strength work.
No. Most Pilates is light to moderate, and the NHS counts it as muscle-strengthening. Walking, cycling or your rehab circuit is your cardio.
Go by how it feels instead: fairly light to somewhat hard, where you can still talk. Beta blockers slow your heart, so heart-rate targets don't fit if you take them.
Leave out the roll-over, jack knife and other legs-overhead moves, breath-hold breathing, long planks and holds, and full push-ups; with heart failure, no planks or press-ups at all. After surgery or a device, follow the arm rules on this page.
It's still strength work, with a little more effort than the mat. Keep springs light to moderate, keep breathing and skip the inverted reformer moves; the heart failure trial used the mat.
Usually, yes, with your team's advice. Our exercise for atrial fibrillation guide explains that exercise is unlikely to make AF worse, that heart-rate readings can be wrong during AF so you go by feel, and that hot classes are best skipped.
Stop for chest pain, palpitations, dizziness or unusual breathlessness. Call 999 for chest pain that feels tight or spreads to your arms, neck or jaw, severe difficulty breathing, or angina that doesn't settle 5 minutes after your second dose of GTN.
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.
