Pilates guide
Pilates is safe for most people with high blood pressure, and it may lower it a little: by about 5/3 mmHg (the units blood pressure is measured in, top number over bottom) in small trials, mostly in women who kept taking their medicines. It's an extra, not your main exercise: walking, cycling or swimming on most days lower blood pressure more reliably, and Pilates never replaces your tablets.
The things to change are simple: keep breathing, keep holds short, and leave out the head-down, legs-overhead moves while your blood pressure isn't under control.
This guide covers what the trials show, how Pilates compares with other exercise, breath holding and straining, head-down moves, the reformer and hot classes, a 30-minute head-up class, and the warning signs.
Across 4 randomised trials and 7 other studies, Pilates lowered blood pressure by about 5/3 mmHg more than comparison groups. A 2026 analysis of trials of different types of exercise found a small fall in 24-hour diastolic pressure (the bottom number) with Pilates, from limited data.
Blood Pressure UK says focus on aerobic activity such as walking, cycling and swimming, and the NHS suggests at least 150 minutes of exercise a week. Pilates adds strength work.
A typical mat class is light to moderate, mat and reformer sessions didn't raise blood pressure above resting in healthy women, and the main review called Pilates safe for people with high blood pressure. If your readings are 180/100 or higher, speak to your doctor or nurse before starting.
Holding your breath while straining sends blood pressure very high, and it rises during any hard hold. Breathe out on the effort, and keep planks and hovers to 15 to 30 seconds.
Skip the roll-over, jack knife, control balance and boomerang while your blood pressure isn't under control. This is a precaution, not a trial finding.
Most Pilates trials were in people who kept taking their tablets, and medicines lower blood pressure more than exercise overall. Never stop or change a medicine because you've started exercising; talk to your GP if your readings fall.
High blood pressure is 140/90 or higher when checked by a health professional, or 135/85 or higher at home. NICE (the National Institute for Health and Care Excellence) calls a clinic reading of 180/120 or higher severe. It usually causes no symptoms; rarely headaches, blurred vision or chest pain.
Blood pressure rises for a short time during exercise and falls afterwards; Blood Pressure UK says that for most people this is nothing to worry about. Over weeks, regular exercise lowers resting blood pressure, and NICE says "a healthy diet and regular exercise can reduce blood pressure".
A typical session averages about 3 METs (a measure of effort: sitting still is 1), which is light to moderate. In 10 people, the top number rose about 7 mmHg straight after a mat class and was back to normal within 5 minutes; in 13 people with high blood pressure, it was about 5 to 8 mmHg lower for the hour after a session.
Holding your breath while straining and long, hard holds raise blood pressure sharply. Head-down positions raise pressure in the head and eyes. Getting up quickly after lying down can make you dizzy, especially on blood pressure medicines.
A 2024 review of 4 randomised trials and 7 other comparative studies in people with high blood pressure found falls of 4.8 mmHg in the top number and 3.4 in the bottom number against comparison groups. The authors called Pilates safe, but said it "may not necessarily offer superior results" to other exercise.
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A 2026 analysis pooled 31 trials of different types of exercise (1,345 people with high blood pressure) and estimated that Pilates lowered 24-hour diastolic pressure by about 4 mmHg, while aerobic, interval and combined training lowered the top number too. The authors called the data on Pilates "limited and imprecise". A second 2026 analysis of 24-hour readings didn't include Pilates among the types it compared.
In 44 women taking blood pressure medicines, an hour of mat Pilates twice a week for 16 weeks lowered clinic and 24-hour blood pressure against no exercise. In 60 similar women, 16 weeks made no significant difference to 24-hour pressure. In 28 women taking medicines, 13 weeks of mat and machine Pilates twice a week lowered 24-hour blood pressure more than usual care, the authors report: the top number fell by 10.3 mmHg within the Pilates group, though the abstract doesn't make the comparison with usual care clear; their mood and sleep improved too. In 34 adults aged 60 to 75, 12 weeks of mat Pilates 3 times a week, lying on the back throughout, brought the top number from 141 to 128, against 145 to 143 in a control group.
Most trials were small, in women, often after the menopause, and in people taking medicines. Young women with obesity and raised blood pressure lowered theirs too, and in older women with type 2 diabetes it fell at 4 and 8 weeks, but 12 weeks of equipment Pilates didn't change it in another group, and some studies had no comparison group.
Across 270 trials, aerobic exercise, strength training, combined training, interval training and isometric holds such as wall sits all lowered resting blood pressure, by about 4 to 8 mmHg in the top number, isometric most. The 2025 American guideline gives aerobic exercise 4 to 8 mmHg in people with high blood pressure. Medicines lowered the top number more than exercise overall.
A registered trial of mat Pilates in 120 people with high blood pressure expected that it might not lower resting blood pressure; its results aren't published yet.
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Mat and reformer sessions in 18 healthy women didn't raise blood pressure above resting, people with high blood pressure had lower readings for an hour after a session, and the review called Pilates safe.
Source 3
In 10 athletes lifting their heaviest leg press, blood pressure averaged 311/284 mmHg when they held their breath and 198/175 when they breathed out slowly. In bodybuilders it peaked at 320/250. During a hold, blood pressure rises with how hard you try, not how much force you make.
The American College of Sports Medicine advises people with high blood pressure to "Avoid heavy weight lifting or breath holding". Pilates loads are light, so the rule that matters is breathing: out on the effort, never holding your breath in a hold.
Lateral breathing and slow breathing without holds are fine. Leave out patterns with breath holds, such as box and 4-7-8 breathing, as our yoga for high blood pressure guide says.
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Isometric training, such as wall sits, lowers resting blood pressure over weeks, and our exercise for high blood pressure guide covers it. In a class, planks, knee hovers and wall sits are fine with steady breathing, kept to 15 to 30 seconds and not to failure (our editorial starting point).
We found no trial of head-down moves in people with high blood pressure. Eye pressure rose within a minute in head-down yoga positions and fell back within 2 minutes after.
While your blood pressure isn't under control, leave out the roll-over, jack knife, control balance and boomerang, and the high scissors and high bicycle, which lift your hips over your shoulders. Keep roll-downs and child's pose brief and come up slowly. In legs up the wall, don't raise your hips. This agrees with our exercise for high blood pressure guide.
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The NHS advises getting up slowly from sitting to standing, and moving slowly from lying to sitting to standing. Roll to your side and sit for a few breaths before you stand, especially after starting or changing blood pressure medicines.
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A GP usually prescribes medicine if blood pressure is very high, your risk is higher, or it stays high after lifestyle changes. Never stop or change a medicine because you've started exercising; talk to your GP if your readings fall.
A reformer session used more energy than a mat session but didn't raise blood pressure above resting in healthy women. A trial using mat and machine Pilates lowered 24-hour blood pressure, and one of equipment Pilates didn't change it. Keep springs moderate, keep breathing, and skip inverted reformer moves while your blood pressure isn't controlled (our suggestion).
The MHRA says blood pressure medicines such as ACE inhibitors, beta-blockers or calcium channel blockers can make it harder to control your temperature, and water tablets add to fluid loss. We found no study of hot Pilates. If you try it, drink water, leave if you feel dizzy or sick, and ask your GP if you take these medicines.
55 to 60 minutes of Pilates, 2 or 3 times a week, for 12 to 16 weeks. For fitness, Pilates needed at least 1,440 minutes in all, such as twice a week for 3 months.
At least 150 minutes of exercise a week (NHS), with aerobic activity first (Blood Pressure UK).
Our editorial starting point:
2 minutes of marching is from our walk and Pilates workout; 5 to 8 lateral breaths and at least 5 minutes of slow breathing, sitting, with no holds, are the move pages' doses.
Breathe out as you push or stand: 2 sets of 8 to 12 sit-to-stands and wall push-ups and 2 sets of 10 to 15 rows are our editorial starting point, and 10 to 12 side leg lifts each side the move page's dose.
8 bridges is from our Pilates for knee pain class, 10 clams each side and 5 bird dogs each side from our beginner Pilates for over-50s class, and 2 sets of 20 seconds of swimming from our walk and Pilates workout; 5 leg circles each way, 6 to 10 single-leg stretches and 8 to 10 side kicks each side, 3 or 4 spine twists and 3 mermaid stretches each way are the move pages' doses.
3D demoPelvic tilt into bridgeBeginner · 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 demoClamshellBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoSpine twist (Pilates)Beginner · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipmentThe roll-over, jack knife, control balance, boomerang, high scissors and high bicycle: leave out while your blood pressure isn't under control (a precaution, not a trial finding).
Box and 4-7-8 breathing: leave out.
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Planks, knee hovers and wall sits: 15 to 30 seconds with steady breathing, not to failure. Ask your GP before wall sit training if your readings are 160/100 or higher and untreated.
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Roll-downs, child's pose and downward dog: keep them brief and come up slowly.
Its own page says don't raise your hips if your blood pressure isn't under control.
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Do the 30-minute head-up class twice a week alongside walking or cycling. The over-50s class has no curl-ups or roll-downs; the chair classes suit anyone who finds the floor hard; the wall sit workout is the isometric extra.
A 30-minute Pilates class for high blood pressure: standing strength, head-level mat work with short holds, no breath holds or inversions, and slow breathing.
30 minBeginner15 movesA bench or box, A wallA 20-minute beginner mat Pilates session for over-50s with no deep or repeated rounding of the spine, plus back strengthening and standing balance.
20 minBeginner13 movesA 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 45-minute session for weight loss and health: a 20-minute brisk walk, which does more for the scales, then a short-rest Pilates circuit for strength.
45 minBeginner11 movesCardio machineThe isometric routine from blood pressure trials: four 2-minute wall sits with 2 minutes' rest, three days a week, with a warm-up and an unhurried cool-down.
22 minBeginner6 movesA bench or box, A wallForty minutes of short-hold poses, slow breathing and a 10-minute relaxation, with no head-down poses or breath holds.
40 minBeginner14 movesA step, Firm cushionThe walking plan builds the brisk activity that lowers blood pressure most.
These are the same warning signs as our exercise for high blood pressure guide. In the US, call 911 where this page says 999.
Stop exercising and call 999 for:
If your readings are 160/100 or higher (NICE's stage 2) and not yet treated, keep walking and keep active, but save hard, heavy or maximal efforts until treatment has brought it under control. Below that, most people can build up straight away. This line is our reading of the guidance above, not a rule from any one guideline.
Come out of any move and sit down if you feel dizzy or light-headed, get a pounding headache or blurred vision; if it doesn't settle within a few minutes, or comes with any 999 sign, treat it as above. Keep breathing in every move, and roll to your side and sit before standing after lying work (our advice).
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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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It's light to moderate exercise, it didn't raise blood pressure above resting in a lab study, and reviews call it safe. The things to change are breath holding, long hard holds and head-down moves.
The trials were mostly in people who kept taking their tablets, and medicines lower blood pressure more than exercise overall. Never stop or change a medicine yourself.
Its effect is small and not shown to beat other exercise; aerobic, combined and isometric training have far more evidence.
Mat Pilates lowered blood pressure in most trials; one equipment programme didn't change it.
Breathe out on the effort. Holding your breath while straining raises blood pressure sharply.
Stress raises blood pressure for a short time, but Blood Pressure UK says "There's no evidence that stress causes long-term high blood pressure". Relaxation is part of a class, not a cure.
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Yes, as an extra. Small trials found it lowered blood pressure by about 5/3 mmHg more than comparison groups, and a 2026 analysis found a small fall in 24-hour diastolic pressure, from limited data. Walking or cycling should still be the main part of your week.
A little, in small trials mostly in women taking medicines. In one trial of 28 women, the top number over 24 hours fell by about 10 mmHg in the Pilates group; in another of 60 women there was no clear difference from no exercise.
For most people, yes: it's light to moderate exercise, and reviews call it safe. If your readings are 180/100 or higher, speak to your doctor or nurse first; at 200/110 or above, don't start any new activity.
While it isn't under control, leave out the roll-over, jack knife, control balance and boomerang: a precaution, not a trial finding. Skip breath-hold breathing and long hard holds, and keep breathing in everything else.
It can be: a reformer session didn't raise blood pressure above resting in healthy women, and a trial using mat and machine Pilates lowered 24-hour blood pressure. Keep springs moderate, keep breathing, and skip the inverted reformer moves.
Neither has been shown to be better; both lower it a little in small trials. Aerobic and isometric exercise have much more evidence.
No. The trials were mostly in people who kept taking their tablets, and medicines lower blood pressure more than exercise overall. Never stop or change a medicine because you've started exercising; talk to your GP if your readings fall.
Briefly and a little: in one study, the top number rose about 7 mmHg straight after a class and was back to normal within 5 minutes. Holding your breath while straining raises it far more, so breathe out on every effort.
Yes, held for 15 to 30 seconds with steady breathing, not to failure. Blood pressure rises during a hold, more the harder you push.
We found no study of it. Some blood pressure medicines make it harder to control your temperature, so if you try it, drink water, leave if you feel dizzy or sick, and ask your GP if you take these medicines.
Trials used 2 or 3 sessions a week of about an hour for 12 to 16 weeks. Twice a week alongside 150 minutes of walking or cycling is a good start; check your home readings after about 12 weeks.
Call 999 for chest pain, severe breathlessness, or signs of a stroke such as a drooping face, a weak arm, speech problems, sudden blurred vision, confusion or a severe headache. Get advice the same day for frequent headaches or blurred vision, or if you feel dizzy, breathless or have palpitations while exercising.
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.
