Pilates guide

Pilates for hikers: hills and descents, knees and ankles, a loaded pack and your back, balance on rough ground, the evidence, and a routine

Hiking and hill walking mean long climbs and descents on uneven ground, often with a pack. Most hillwalking injuries are to the ankles and lower legs after a slip or a trip, and most falls happen on the way down. Pilates can add one-leg balance, ankle range and calf work, hip strength and a trunk that holds up under a pack, at low load on a rest day. No study has tested Pilates in hikers.

So Pilates sits beside the real preparation, never in place of it: walking and hill fitness, leg strength for climbs and lowering strength for descents, poles on the way down, a sensible pack, and planning for the weather and the route. Walkers, trekkers and backpackers will find the same advice applies.

This guide covers descents and knees, ankles and balance on rough ground, the pack and your back, older hikers and the heart, what the evidence shows, a 25-minute class and the warning signs, including heat and cold.

The short version

No Pilates trial in hikers

No trial has tested Pilates in hikers, hillwalkers, trekkers or backpackers, and no trial has tested any programme to prevent hiking injuries. Pilates is balance, hip, ankle and trunk work beside walking, hills and strength training, not hiking training in itself.

Source 1

Ankles, slips and the way down

In Scotland's mountain rescues in 2025, slips and trips were the commonest cause and the ankle took 34% of injuries. In the Austrian Alps, 75.3% of hikers who fell did so on the descent.

Sources 2, 3

Descents load the knee

Modelled knee forces on a steep downhill ramp were about double those on the flat, and a long descent upset older adults' balance for up to 2 days. Poles and a little lowering practice before a trip are what helped in studies.

Sources 4, 5, 6, 7

Balance training is the useful part

In sport, balance training cut ankle sprains by about 40%, and by about half in people who had sprained an ankle before. None of these trials was in hikers, but Pilates one-leg work counts if you make it harder over time (our reading).

Sources 8, 9

The heart comes first for older hikers

In Austrian data published in 2007, about half of deaths in mountain hiking were sudden cardiac deaths, mostly in men over 34 with a past heart attack, diabetes or high cholesterol. The data are old, but the heart lines lead this page's warning signs.

Sources 10, 11

Pilates isn't hill fitness

A Pilates session uses about as much energy as walking slowly. Walking, stairs and hills build the fitness a hike needs.

Source 12

What hiking asks of your body, and where Pilates fits

Each note keeps its own group and measure; rescue and accident records count different things.

Climbs and descentsEmerging evidence

Going up, the hips, thighs and calves lift you and your pack; going down, the thigh muscles lower you under control, and the knee takes much more load. Modelled in 12 healthy adults on a 19% downhill ramp, the force through the knee reached 8 times body weight, against 3.9 on the flat. Measured with instrumented knee implants in 5 people, going down stairs put 346% of body weight through the knee, against 261% walking on the flat. In 18 men on slopes up to 18 degrees, walking downhill raised hip, knee and kneecap forces. These are lab studies, and the first loads are modelled.

Sources 4, 13, 14, 15

Tired legs and balance on the way downEmerging evidence

Thirty minutes of simulated downhill walking upset young adults' leg control without weakening their legs. In 19 adults aged about 72, it raised sway by 66% to 256%, slowed a walking test by 29% and left knee strength 27% to 38% down 48 hours later, while level walking didn't. It also blunted the sense of knee position in 24 sportswomen. Mountain Rescue England and Wales notes that "Many accidents occur towards the end of the day when both you and your phone are low on energy".

Sources 16, 5, 17, 18

Where hikers get hurtStrong evidence

Each figure keeps its own population.

  • Scottish mountain rescue, 2025 (491 mountaineering incidents, 94% of them hillwalking): slips and trips were the commonest cause; 29% of the people helped were injured, most often at the ankle (34% of injuries), lower leg (18%), head (12%) and knee (10%). Suspected ankle fractures were 28% of women's injuries against 10% of men's.
  • Falls while hiking in the Austrian Alps, 2006 to 2014 (5,665 people): 75.3% fell on the descent and 80.9% were on marked trails or paths; 5.8% died.
  • Hiking accidents in the Austrian Alps, 2015 to 2021 (7,552 people): 7.1% were fatal; men had most of the heart and circulation emergencies, and women most of the fractures and ankle and foot injuries.
  • Hikers in 7 studies (17,757 injured people): blisters and ankle sprains were the commonest injuries, and the legs the commonest site in every study.

Sources 2, 3, 19, 20

Older hikersEmerging evidence

In 10,185 Swiss Alpine hiking emergencies from 2009 to 2018, injuries were more severe the older the hiker. In 405 people hurt in falls while hiking in Tyrol, the average age was 56, 70% reported poor eyesight and 83% carried a pack.

Sources 21, 22

Long-distance hikersMixed evidence

In 1,295 Appalachian Trail thru-hikers, 61% reported muscle or joint problems, and those who hadn't trained beforehand had 2.82 times the odds of injury. Strength training, stretching or yoga and endurance training went with fewer injuries, which a self-report survey can't show they caused.

Source 23

What Pilates offers, and what it doesn't

Pilates can train one-leg balance and ankle control, made harder over time; hip strength for the climbing and landing leg; calf and shin strength; and trunk and upper-back endurance for a pack, in a low-load session on a rest day (our reading). It can't replace walking and hill fitness, leg strength for climbs, lowering strength for descents, poles, a lighter pack, or planning for the weather, the route and your kit. A Pilates session uses about as much energy as walking at 3.2 km/h, and less than walking at 4.8 km/h. Across 11 trials, Pilates built strength no better or worse than other exercise, at very low to low certainty.

Sources 12, 24

What the evidence says

Pilates for hiking is untested. The evidence it borrows is balance training for ankle sprains in sport, and Pilates and falls research in older adults.

No Pilates trial in hikersStrong evidence

Our searches of PubMed, Europe PMC and ClinicalTrials.gov on 1 November 2026, for Pilates with hiking, trekking, hillwalking, backpacking, load carriage or Nordic walking, and for balance, core or strength training in hikers, found no trial in hikers.

Source 1

Pilates, walking and balance in older adultsMixed evidence

In a UK randomised trial in 61 healthy older adults, 12 weeks of Pilates twice a week improved step and double-support time against controls, but falls weren't followed for long enough. Smaller studies report better walking after ankle-focused Pilates in 22 older women (no comparison group) and in 22 women with flexible flat feet (a pilot trial). None were in hikers, and none tested balance on rough or sloping ground.

Sources 25, 26, 27

Pilates and balance tests, but not fallsEmerging evidence

Across many small trials, Pilates improved balance tests in older adults, about as much as other exercise. The newest review (39 studies, only 14 of satisfactory quality) recommends it for balance but not to reduce the number of falls or the fear of falling. The one pilot trial that counted falls (53 people aged 60 and over) found 42% fewer fall injuries, which wasn't statistically significant.

Sources 28, 29, 30, 31, 32, 33

What prevents falls in older adultsStrong evidence

Exercise cut the rate of falls in older people living at home by 23% (59 studies, high-certainty evidence), and programmes that challenged balance and gave more than 3 hours a week did best. The world falls guidelines recommend balance-challenging and functional exercise 3 or more times a week, made harder over time, for at least 12 weeks. The NHS asks adults 65 and over to do activities that improve strength, balance and flexibility on at least 2 days a week.

Sources 34, 35, 36, 37

Balance training and ankle sprains, borrowed from sportStrong evidence

In high school athletes, balance training cut sprains (6.1% against 9.9%). After a sprain, an 8-week home balance programme cut repeat sprains over a year from 33% to 22%. Across 17 studies, balance training cut sprains (risk ratio 0.59), more after a previous sprain (0.49), and across 13 trials of 1,476 athletes, neuromuscular training more than halved ankle injuries. Reviews rate the evidence for preventing repeat sprains as moderate. None of these trials was in hikers.

Sources 38, 9, 8, 39, 40

Poles and lowering practiceEmerging evidence

On a steep descent, poles cut knee forces by 12% to 25% in 8 men, and they lowered joint loads walking downhill with a day pack and an expedition pack in 15 male hikers. After walking up and down Snowdon, 37 walkers with poles had less soreness and kept more strength. On the flat, pushing harder on poles didn't reduce knee compression, and in knee arthritis poles slightly raised one knee load. Five minutes of downhill walking a week before a 40-minute descent cut strength loss, muscle damage markers and soreness by 47% to 64% in 36 young men, and across 23 studies, one bout of lowering work 2 to 4 days beforehand reduced soreness.

Sources 6, 41, 42, 43, 44, 7, 45

Core training and loaded walkingMixed evidence

In 39 novice US military trainees, 3 weeks of core exercise 3 times a week improved the time for an 8 km march with a 16 kg rucksack by 5 to 6 minutes against controls: small, short, military and not Pilates. Across 10 military studies, strength plus aerobic training at least 3 times a week for 4 weeks or more gave large gains in loaded marching, and adding progressive load carriage the most.

Sources 46, 47

Hiking itself, in older adultsMixed evidence

A 7-day hiking holiday improved standing balance in 106 adults aged 65 to 85 against a sightseeing holiday, but not walking or moving balance, and spa treatment was part of it. Twice-weekly hiking for 8 weeks improved walking fitness in 27 adults aged 55 to 75, without a comparison group.

Sources 48, 49

What prevents sports injuriesStrong evidence

Across 25 trials, strength training cut sports injuries to about a third and balance training to about half, while stretching made no difference. Firm evidence that a weak core causes injuries is lacking.

Sources 50, 51

Descents and knees

What Pilates can and can't do

Pilates has no move that loads your thighs while they lengthen the way a long descent does. Hip and calf work and one-leg control help you hold the knee in line (our reading); the strength for descents comes from slow step-downs and from walking downhill, built up before a big trip. The step-down in our class is strength work borrowed from the hiking training workout.

Sources 4, 7

A little lowering practice protectsEmerging evidence

In 36 young men, 5 minutes of downhill walking a week beforehand cut strength loss, muscle damage markers and soreness from a 40-minute descent by 47% to 64%, and the authors write that "performing small volume of downhill walking is crucial in preparation for trekking". Stairs or a hill in the weeks before a trip do the same job (our reading).

Sources 7, 45

Poles on the way downEmerging evidence

A review concluded that poles "decrease lower extremity loading and forces but increase cardiovascular demand". They help most on steep descents; on the flat they don't reduce the load on your knees.

Sources 6, 52, 43

Knee pain on descents

Use a lower step for the step-downs, shorten your stride on the way down, and see our knee pain when hiking guide, which has the stages and the pain rule in the warning signs below.

Ankles and balance on rough ground

How much balance workEmerging evidence

The home programme that cut repeat sprains ran for 8 weeks, and falls programmes that work challenge balance 3 or more times a week for at least 12 weeks. Make one-leg work harder every week or two: eyes closed, head turns, a cushion, then reaches (our suggestion).

Sources 9, 36

Sprains come backEmerging evidence

Ankle sprains often recur, and many people go on to an ankle that keeps giving way. If you've sprained an ankle before, the balance block matters most, and our ankle sprain and chronic ankle instability guides have the stages.

Source 53

Flat floor, rough trail

Pilates balance work is done on a flat floor; trails aren't flat. Practise at home, and on the hill use poles, shorter steps on descents and an easier pace when you're tired (our suggestion).

Your pack and your back

What a pack doesEmerging evidence

Across 54 studies, packs tilted the trunk forward and shortened strides. In 15 experienced women hikers walking 8 km, a pack of 20% of body weight already changed trunk posture and raised shoulder discomfort, and the researchers suggested a limit of 30% (one small lab study). With a hip belt, about 30% of the load went to the hips and 70% to the upper back and shoulders in 11 men, and in a computer model a hip belt lowered the load on the lower back only walking downhill.

Sources 54, 55, 56, 57

Packs and painMixed evidence

Across 47 studies, the evidence that carrying loads provokes back, neck and shoulder pain is "conflicting but positive", from weak studies. Reviews of soldiers' loads advise keeping the load close to the body: "Hip belts on rucksacks should be used whenever possible".

Sources 58, 59

Where Pilates fits under a pack

Trunk and upper-back endurance for the hours under a pack: the hundred, dead bug, bird dog, side plank, swimming and Y-T-W raises (our reading). Pack weight is the bigger lever, and our hiking guide covers it; for back pain on the trail, see our lower back pain when hiking guide.

Source 46

Older hikers: the heart, balance and bones

The heartEmerging evidence

In Austrian data published in 2007 (deaths recorded over nine years; the years themselves aren't given in what we could read), about half of deaths in mountain hiking were sudden cardiac deaths. Compared with 537 matched hikers, the 179 men over 34 who died suddenly had more often had a heart attack (17% against 0.9%), diabetes (6% against 1%) or high cholesterol (54% against 20%), and less often did regular mountain sport (31% against 58%). A 2021 review of the same data found about half of these deaths happened on the first day, and advises rests with food and drink every 30 to 60 minutes. These figures are old. In a survey of 1,431 hikers in the Austrian Alps, 12.7% had at least one heart or circulation disease.

Sources 10, 11, 60

Balance and fallsEmerging evidence

Pilates improves balance tests in older adults but hasn't been shown to cut falls. Falls programmes that work challenge balance 3 or more times a week for at least 12 weeks, so keep walking, the hiking training workout and balance practice going between trips.

Sources 28, 36

Bones

Women had most of the fractures in Austrian hiking accidents. With osteoporosis or a past fracture from a minor fall, keep your head down in the hundred and similar curl-ups, and leave out the roll-up, rolling like a ball, roll-over and teaser, as their move pages say.

Source 19

Pilates core exercises for hiking and backpacking

The Pilates version

The hundred, dead bug, bird dog, side plank and swimming for trunk endurance, and Y-T-W raises for the shoulders under the straps. Trunk training improves trunk endurance most, and in one small military trial core training improved loaded march time. It hasn't been shown to prevent falls or knee pain.

Sources 61, 46

Does hiking strengthen your core?

Carrying a pack makes your trunk work, and climbing works the hips and legs hard, but hiking doesn't train trunk endurance in every direction. A short Pilates or core session twice a week fills that gap (our suggestion).

Source 54

Fitting Pilates into your hiking week

When to do it

Two or three 25-minute sessions a week on days you don't hike, made a little harder every week or two, alongside the hiking training workout (our suggestion). Not the day before a long or steep hike, and never instead of walking, stairs and hills.

Before you set off

Walk the first 10 minutes at an easy pace and do a few moving drills, as our hiking guide's warm-up does. Long held stretches just before hard efforts cost a little performance, so save Pilates holds for rest days.

Source 62

Plan the day

AdventureSmart UK suggests three questions before you set off: am I confident I have the knowledge and skills for the day, do I know what the weather will be like, and do I have the right gear? Mountain Rescue England and Wales has more safety advice.

Sources 63, 18

Ankles and calves, before your boots hold them

Ankle CARs, 5 slow circles each way with each ankle, morning and evening (the move page's dose); knee-to-wall ankle rock, 10 slow rocks per side, daily (the move page's dose); slow calf raise, 12, up for 2 and down for 3 (our Pilates after ankle sprain class); tibialis raise, 10 (our Pilates after ankle sprain class), building to 2 sets of 15 to 20 as in the hiking training workout once it's easy.

One-leg balance for rough ground

Single-leg stand, 3 holds of up to 30 seconds each leg (our Pilates after ankle sprain class), then eyes closed, head turns or a cushion; heel-to-toe stance and walk, a 10-second hold each way, then 5 steps heel to toe, twice (our Pilates for balance class), beside a counter; hip airplane, 2 sets of 5 slow turns each leg (the move page's dose), holding a counter; single-leg reach matrix, 3 rounds of 5 reaches in each direction, each leg (the move page's dose), once a 30-second one-leg stand is steady.

The lowering leg, for descents

Step-down, 2 to 3 sets of 8 slow lowers each leg from a low step (the hiking training workout): strength work, not Pilates, but it belongs beside it; shoulder bridge, 3 to 5 kicks each leg (the move page's dose).

Hips for the climbing and landing leg

Side kick, 8 to 10 each side (the move page's dose); clamshell, 10 each side (our Pilates for skiers class); inner thigh lift, 10 to 12 each side (the move page's dose).

A trunk and upper back for the pack

Hundred, 50 beats to start, building to 100 (the move page's dose), head down with osteoporosis, as its page says; dead bug, 2 sets of 8 each side (our Pilates for skiers class); bird dog, 2 sets of 8 each side (the hiking training workout); side plank, 2 sets of 20 to 30 seconds each side (the hiking training workout), knees down to start; swimming, 2 to 3 sets of 20 to 30 seconds (the move page's dose), or bird dogs if arching hurts; Y-T-W raises, 5 of each shape (our Pilates for weightlifters class); thoracic rotation, 6 rotations per side, moving with the breath (the move page's dose).

What to change or leave out

Osteoporosis, or a fracture from a minor fall

Use head-down versions of the hundred, single-leg stretch and criss-cross, and leave out the roll-up, rolling like a ball, roll-over and teaser, as their pages say. Rolling like a ball's page: "Not recommended with osteoporosis or a higher risk of fracture".

Source 19

Balance work

Do it beside a counter with a chair behind you, never on the trail when you're tired (our suggestion). The single-leg stand's page: with vertigo, dizziness on standing or a recent fall, stay within arm's reach of something solid and have someone nearby.

Sore knees on descents

Step down from a low step and keep the knee bend small, as the step-down's page says: with pain at the front of the knee, start with low step-ups and add step-downs from a low step once those are comfortable. Pad your knees in all-fours moves.

A painful Achilles

No heel drops below the level of a step until it has been assessed, as the step calf raise's page says, and see our Achilles guide (our suggestion).

Back pain under a pack that's worse arching

Use the bird dog instead of swimming, as the swimming page says, and see our lower back pain when hiking guide.

Heart disease or high blood pressure

Keep breathing in holds and planks, as the side plank's page says: with heart disease, keep breathing and ask your cardiac team before long holds, and with heart failure, avoid planks. See your GP before a big trip.

Source 10

After a long or hot hike

Drink and cool down first, and leave the balance block for a fresh day (our suggestion).

Classes to follow

Our 25-minute trail class works the ankles, a trunk for the pack, hips, the lowering leg and one-leg balance. It doesn't replace the hiking training workout (step-ups, lowering and carries) or the hill and stair session. The balance class suits older hikers and anyone unsteady, the ankle sprain class a hiker with a past sprain, and the knee pain class sore knees; the walk and Pilates workout pairs the two for beginners.

Trail-ready Pilates for hikers: a 25-minute class for ankles, a trunk that carries a pack, hips, the lowering leg and one-leg balance

A 25-minute Pilates class for hikers: ankles and calves, a trunk for your pack, hips, slow step-downs for descents and one-leg balance for rough ground.

25 minBeginner18 movesWall, step

Hiking training workout

A 35-minute strength workout for hikers: step-ups, lunges and calf raises for climbs, slow step-downs for descents, single-leg hinges, carries and balance.

35 minBeginner13 movesWall, step

Hill and stair conditioning

Stair or hill climbs with the walk down as recovery, then a loaded walk with your rucksack, building towards the hills, pack and days of your trip.

40 minBeginner5 movesStep, something with weight

Trail yoga: a 25-minute class for after a hike or a rest day, with a 10-minute standing version

A 25-minute yoga class for hikers: a 10-minute standing stretch for after a hike, then balance, legs and floor blocks for rest days.

25 minBeginner16 movesWall

Standing Pilates for balance: a 25-minute counter and mat class

A 25-minute Pilates class for steadier balance: standing balance and leg strength at a kitchen counter, then mat work for your trunk and hips.

25 minBeginner17 movesWall, bench or box

Ankle-steadying Pilates after a sprain: a 25-minute class for ankle strength, hips and one-leg balance

A 25-minute Pilates class for the weeks after a sprained ankle: footwork on a wall, band work in every direction, side-lying hip work and a balance progression.

25 minBeginner18 movesBench or box, wall

Pre-season Pilates for skiers: a 25-minute class for trunk, hips and single-leg balance

A 25-minute Pilates class for skiers: trunk endurance, hips and thighs, wall sits and single-leg balance, for the 6 to 8 weeks before your trip.

25 minBeginner17 movesWall, band

Pilates for knee pain: a 25-minute class with no kneeling

A 25-minute Pilates class for sore knees and knee arthritis: lying and side-lying leg work, shallow squats and balance, with no kneeling at all.

25 minBeginner15 movesBench or box, something with weight

Walk and Pilates workout

A 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 machine

Beginner Pilates for over-50s

A 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 movesWall

Plans

The walking plan builds the walking a hike needs; the beginner Pilates plan builds the Pilates basics over 4 weeks, 3 days a week.

When to stop and get help

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.

On the hill: call 999 or 112

For an injury, illness or someone lost or overdue, dial 999 or 112 and ask for the Police, then Mountain Rescue.

Source 64

Chest pain or fainting: call 999

Call 999 if:

  • You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
  • The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
  • You have chest pain and feel sweaty, sick, light-headed or short of breath.
  • Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 65, 66

The heart: check first, and know the signs

Sudden cardiac death while hiking was linked with a previous heart attack, coronary artery disease, diabetes and high cholesterol in men over 34. See your GP before a big trip, build up regular hill walking, and take the first day easy.

Call 999: chest pain that feels tight or like squeezing on your chest; chest pain that's spreading to your arms, neck or jaw; severe difficulty breathing (you're gasping, choking or not able to get words out); lips or skin that are pale, blue or grey (on brown or black skin this may be easier to see on the palms of the hands); or someone who has passed out and is not responding normally. It could be a heart attack. Don't drive yourself to A&E.

Get help from NHS 111: pain or tightness in your chest, neck, shoulders, jaw or arms that comes and goes, often brought on by exercise, stress, emotion or cold and easing after a few minutes' rest. It can be angina, a sign of a heart problem. If you've been diagnosed with angina, get help from NHS 111 too if it feels worse than before, is happening more often, lasts longer or happens when you're resting.

The PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) asks about a heart condition or high blood pressure, chest pain, dizziness or losing consciousness, other long-term conditions and their medicines, a bone or joint problem that activity could make worse, and being told to exercise only under supervision. If you answer yes to any, check with your GP or a qualified exercise professional first. If you're over 45 and not used to hard exercise, ask a qualified exercise professional before the hardest sessions, and delay if you're ill.

Sources 10, 67, 68, 69

Heatstroke

The NHS says to call 999 for signs of heatstroke: still being unwell after 30 minutes of resting somewhere cool, being cooled and drinking; a very high temperature; hot skin that isn't sweating; a fast heartbeat; fast breathing or breathlessness; confusion and lack of coordination; a seizure; or loss of consciousness.

Source 70

Hypothermia and frostbite

Call 999 or go to A&E (accident and emergency) for hypothermia, such as shivering, pale cold skin, slurred speech, slow breathing, tiredness or confusion, and for frostbite with hard, frozen skin, swelling and loss of feeling, or blisters. Mountain Rescue England and Wales lists the signs to watch for in others: "Disorientation, confusion, shivering, tiredness, pale complexion and loss of circulation in hands or toes", adding that children and older people are especially at risk.

Sources 71, 72, 18

An ankle injury after a slip or fall

Call 999 or go to A&E: after an injury, you heard a crack, the foot or ankle has changed shape or points at an odd angle, a bone is sticking out, there is a bad cut over it, you're in severe pain, or the toes look blue or white, feel numb or are cold to touch. These can mean a broken bone. Don't drive yourself.

Same day (NHS 111 or an urgent treatment centre): after an injury, you can't put weight on it or walk more than a few steps, the pain is very bad or getting worse, there is a lot of swelling or bruising or it is getting worse, it feels very stiff, or it's not feeling any better after treating it yourself. Get the same help if you also have a very high temperature, or feel hot, cold or shivery: this could be an infection. If you think it's broken, don't treat it yourself.

Same day: a sudden snap or pop at the back of the heel or calf, or a feeling of being kicked there, then walking flat-footed and being unable to push off, stand on tiptoe or climb stairs. It could be an Achilles tendon rupture or a broken heel bone. Go to A&E or a minor injuries unit, or contact NHS 111.

See a doctor or physiotherapist if:

  • An ankle that keeps giving way months after a sprain.

Sources 73, 74, 75

A knee or other leg injury

Call 999 or go to A&E if you heard a crack, the injured part has changed shape or points at an odd angle, it's numb or tingling, or the skin has turned blue or grey or is cold. Get help from NHS 111 if it's very painful or swollen, you can't put weight on it or walk more than a few steps, or a knee locks or gives way.

Go to A&E (accident and emergency) if you've injured your knee and it has changed shape, it becomes very swollen very quickly, you felt a pop or snap, you can see bone sticking out, or it's bleeding heavily. Don't drive yourself: ask someone to take you, or call 999 if the pain means you can't move your leg to get there.

Get advice from NHS 111 now: you cannot move the knee or put any weight on it, or it is very painful, badly swollen or has changed shape, or it locks, gives way or clicks painfully. A pop, quick swelling and a knee that gives way point to an ACL injury: our ACL injury guide says what to do.

Source 76

Knee pain on descents: the pain rule

Our knee guides use this rule: rate your knee pain from 0 to 10 during and after exercise; 0 to 2 counts as safe, up to 5 as acceptable and above 5 as too much, and your knee should be back to its usual level by the next morning.

Sources 77, 78

A fall, for older hikers

Call 999 if you or someone else has fallen and may have hurt the head, back, neck or hip, or cannot get up. Get help from NHS 111 after a fall if you may be in pain, injured or unwell.

Call 999 or go to A&E: severe hip pain after a fall or injury, or you cannot stand, walk or put weight on the leg. In an older adult this can be a broken hip; the leg may be at an odd angle or look shorter. Don't drive yourself.

Source 79

Unusual 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 80

Altitude: get medical help straight away

The NHS says to get medical help immediately, and go 300 to 1,000 m lower if you can, if someone with altitude sickness feels very unwell, is confused, has problems with balance or coordination, sees or hears things that aren't there, is short of breath at rest, has a cough with frothy or bloody spit, has blue or grey skin, lips, tongue or nails, or is very sleepy or hard to wake.

Source 81

During a session

A joint pain that is sharp, gets worse during a session, lingers into the next day or changes how you move is a reason to use an easier version, and to see a GP or physiotherapist if it keeps happening (the rule in our plans).

Source 82

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 83

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.

Source 83

Myths

"Walking poles fix knee pain on their own"Emerging evidence

Poles cut knee forces on a steep descent and reduced soreness after a mountain walk, but they don't reduce knee load on the flat, they slightly raised one knee load in people with knee arthritis, and no trial has tested them for knee pain. Lowering practice, strength work and our knee pain when hiking guide sit beside them.

Sources 6, 42, 43, 44, 52

"Pilates prevents falls on the trail"Mixed evidence

Pilates improves balance tests in older adults but hasn't been shown to cut the number of falls, and most hiking falls happen on the descent, on marked paths. Footing, poles, pacing and balance training made harder over time are what the evidence points to.

Sources 28, 33, 3

"A strong core stops back pain under a pack"Mixed evidence

No trial has tested it in hikers. One small military trial found core training improved loaded march time, and the evidence that loads cause back pain comes from weak studies. Pack weight, a hip belt and a load close to your back come first.

Sources 46, 58, 59

"Downhill is the easy part"Emerging evidence

Knee loads roughly double walking downhill, three quarters of Austrian hiking fall victims fell on the way down, and a long descent upset older adults' balance for up to 2 days.

Sources 4, 3, 5

"Pilates is enough training for a hike"Emerging evidence

A Pilates session uses about the energy of a slow walk. Hill and loaded-walking fitness and leg strength come from walking, stairs, hills and strength training.

Sources 12, 47

"A strong core prevents all injuries"Strong evidence

Firm evidence that a weak core causes injuries is lacking; the programmes that cut injuries trained strength and balance, and stretching didn't help.

Sources 51, 50

"You need a reformer for real Pilates"Mixed evidence

In the one trial that compared them in athletes (footballers), both mat and reformer Pilates improved tests, the reformer slightly more on three, and the balance trials in older adults mostly used mat and standing work. Use what you can get to.

Sources 84, 29

"Pilates flushes out lactic acid and speeds recovery"Mixed evidence

The claim appears on a Pilates body's own blog, but 4 weeks of gentle mat Pilates didn't change lactate in active women, and daily slow breathing added nothing to recovery after hard interval training.

Sources 85, 86, 87

Questions people ask

Is Pilates good for hiking?

It can add one-leg balance, ankle control, hip strength and a trunk that copes with a pack, at low load on a rest day. No study has tested Pilates in hikers, so treat it as a sensible extra to walking, hills and strength work, not a replacement.

Will Pilates help my knees on descents?

Not directly. Knee loads roughly double walking downhill; what helped in studies is a little lowering practice before a trip, strength work such as slow step-downs, and poles on the way down. Pilates hip and calf work sits beside them.

Can Pilates stop me spraining an ankle?

It hasn't been tested. Balance training cut sprains by about 40% in sport, and by about half after a previous sprain, so Pilates one-leg work, made harder over time, is the useful part.

Is Pilates or walking better?

They do different jobs. Walking and hill walking build the fitness a hike needs, and a Pilates session uses about as much energy as a slow walk; Pilates adds balance, hips and trunk endurance.

Is Pilates good for hikers over 60?

Yes, as balance and strength work: Pilates improves balance tests in older adults about as much as other exercise, though it hasn't been shown to cut falls. Falls programmes that work challenge balance 3 or more times a week for at least 12 weeks, and with osteoporosis, keep your head down in curl-ups.

What Pilates core exercises help with a heavy pack?

The hundred, dead bug, bird dog, side plank and swimming for trunk endurance, and Y-T-W raises for the shoulders under the straps. One small military trial found core training improved loaded march time, but pack weight and a hip belt matter more.

Does hiking strengthen your core?

Carrying a pack makes your trunk work, and climbing works your hips and legs hard, but hiking doesn't train trunk endurance in every direction. A short Pilates or core session twice a week fills that gap.

Should I do Pilates before a hike?

No: walk the first 10 minutes at an easy pace and do a few moving drills, as our hiking guide's warm-up does. Keep Pilates for rest days, and not the day before a long or steep hike.

Is Pilates good for recovery after a hike?

A gentle session can feel good, but Pilates isn't a proven recovery treatment. A little downhill walking or lowering work in the days before a trip did more to protect legs from soreness in studies.

Is reformer Pilates good for hikers?

It can add spring resistance for the legs and hips; no study has compared it with mat Pilates in hikers. Use what you can get to, and keep the balance work standing.

I have a heart condition. Can I do Pilates and hill walking?

Often yes, but in older Austrian data, sudden cardiac death on the hill was linked with a past heart attack, diabetes and high cholesterol, and about half happened on the first day. See your GP before a big trip, build up regular hill walking, and keep breathing in Pilates holds.

Sources

  1. PubMed, Europe PMC and ClinicalTrials.gov · Our searches for Pilates, core, balance and strength training trials in hikers: none (November 2026)
  2. Scottish Mountain Rescue 2026 · Statistics report 2025 (annual report, April 2026; read in full)
  3. Faulhaber 2017 · Falls among 5,665 hikers in the Austrian Alps, 2006 to 2014 (police data study, BMJ Open Sport Exerc Med; its 2018 correction adds a grant number; read in full)
  4. Kuster 1997 · Knee loads walking downhill, modelled in 12 adults (lab study, J Bone Joint Surg Br)
  5. Hill 2020 · Balance and strength after downhill and level walking in 19 older adults (lab study, Front Physiol; read in full)
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  7. Maeo 2017 · A short downhill walk protects against muscle damage from a long one: 36 young men (randomised lab study, PLoS One; read in full)
  8. Wang 2023 · Preventing ankle sprains: 17 studies (systematic review and meta-analysis, Clin Rehabil)
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  26. Choi 2021 · Ankle-focused Pilates and walking in 22 older women (uncontrolled study, J Women Aging)
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  29. Barker 2015 · Pilates for balance in older adults (systematic review and meta-analysis, Arch Phys Med Rehabil)
  30. Moreno-Segura 2018 · Pilates, balance and falls in older adults: 15 trials (systematic review and meta-analysis, J Aging Phys Act)
  31. Casonatto 2020 · Pilates and postural balance in older adults: 6 trials (systematic review and meta-analysis, Complement Ther Med)
  32. Fernández-Rodríguez 2021 · Pilates, physical performance and falls risk in older adults: 39 studies (systematic review and meta-analysis, Physiotherapy)
  33. Barker 2016 · Pilates to reduce falls risk in 53 older people (pilot randomised trial, Clin Rehabil)
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  35. Sherrington 2017 · Exercise to prevent falls in older adults (systematic review and meta-analysis, Br J Sports Med)
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  37. NHS · Physical activity guidelines for older adults
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  52. Hawke 2020 · Trekking poles: helping or hindering? (review, Wilderness Environ Med)
  53. Gribble 2016 · The prevalence, impact and long-term consequences of ankle sprains (evidence review for the International Ankle Consortium, Br J Sports Med)
  54. Liew 2016 · Backpacks and walking: 54 studies (systematic review and preliminary meta-analysis, J Appl Biomech)
  55. Simpson 2011 · Pack weight, posture and discomfort in 15 women hikers over 8 km (lab study, Appl Ergon)
  56. LaFiandra 2004 · How a pack's load splits between the upper and lower back in 11 men (lab study, Med Sci Sports Exerc)
  57. Sturdy 2025 · Slopes, heavy backpacks and lower back forces (computer model study, J Biomech Eng)
  58. Golriz 2011 · Load carriage and pain: 47 studies (systematic review, J Back Musculoskelet Rehabil)
  59. Knapik 2004 · Soldier load carriage (review, Mil Med)
  60. Faulhaber 2007 · Heart and circulation disease in 1,431 hikers and 1,043 skiers in the Austrian Alps (survey, High Alt Med Biol)
  61. Saeterbakken 2022 · Trunk training in athletes: 31 studies, 693 athletes (systematic review and meta-analysis, Sports Med; read in full)
  62. Behm 2016 · Stretching, performance, range of movement and injury (systematic review, Appl Physiol Nutr Metab)
  63. AdventureSmart UK · Three questions before you set off (read in full)
  64. Mountain Rescue England and Wales · Getting help (read in full)
  65. NHS · Chest pain (past its review date: reviewed August 2023, review due August 2026)
  66. NHS · Fainting
  67. NHS · Heart attack
  68. NHS · Angina
  69. PAR-Q+ Collaboration · The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), 2025 version (read in full)
  70. NHS · Heat exhaustion and heatstroke
  71. NHS · Hypothermia (past its review date: reviewed June 2023, review due June 2026)
  72. NHS · Frostbite
  73. NHS · Ankle pain
  74. NHS · Sprains and strains
  75. NHS · Broken ankle
  76. NHS · Knee pain
  77. Thomeé 1997 · Treating kneecap pain in 40 young women with a pain-monitoring model (randomised trial, Phys Ther)
  78. Ageberg 2010 · NEMEX-TJR neuromuscular training for severe hip or knee osteoarthritis, and its pain rule (feasibility study, BMC Musculoskelet Disord)
  79. NHS · Falls
  80. NHS · Shortness of breath
  81. NHS · Altitude sickness (past its review date: reviewed July 2023, review due July 2026)
  82. NHS · How to warm up before exercising (with the NHS exercise video safety information)
  83. NHS · Pilates for beginners (exercise video, with safety information)
  84. Yılmaz 2025 · Mat or reformer Pilates in 30 football players (randomised trial, PLoS One; read in full)
  85. Pilates Method Alliance · Why athletes love Pilates (blog; an example of untested claims; read in full)
  86. Moon 2022 · Low-intensity mat Pilates, aerobic capacity and recovery in 10 active women (study, Phys Act Nutr)
  87. Raidl 2026 · Slow breathing as recovery after sprint interval training (randomised trial, Int J Sports Physiol Perform)

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.