Pilates guide
Low blood pressure is a reading below 90/60 mmHg. If yours is naturally low and you feel well, it doesn't need raising, and Pilates is fine. The trouble usually comes when you stand up: a drop in blood pressure as you get up from lying or sitting can make you light-headed, dizzy or faint. In a Pilates class, that means getting up off the mat, rolling up quickly and standing still after floor work, more than the moves themselves.
No trial has tested Pilates for low blood pressure. What helps is plain: moving and squeezing your legs before and as you stand, keeping your head up, drinking enough, avoiding heat, and getting up in stages. This guide shows how to build those into a class, which moves to change, what to do if you feel faint, how to tell low blood pressure from PoTS and vertigo, when it needs checking, and a 25-minute class. Pilates goes alongside a check for the cause of dizziness or fainting, never in place of one.
The NHS: "Low blood pressure is a reading of less than 90/60mmHg. It does not always cause symptoms, but you may need treatment if it does." Blood Pressure UK says naturally low blood pressure probably won't cause you any problems. Pilates can't, and doesn't need to, raise a healthy low reading.
Symptoms when you stand up or change position point to postural hypotension, which affects about 1 in 5 people over 60. In a Pilates class that means getting up off the mat, rolling up fast from lying, and standing still after floor work.
Our searches found no study of Pilates in low blood pressure, blood pressure on standing or fainting. The Pilates blood pressure studies didn't measure people standing, and none recruited people with low blood pressure.
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After a session, blood pressure is a few mmHg lower for an hour or more, and standing still afterwards makes feeling faint more likely. So the end of a class is the time to take care.
Crossing your legs and tensing your leg, buttock and tummy muscles raises blood pressure within seconds, and learning these moves cut repeat faints in a trial. Working the legs before standing reduced the early drop in older adults in a small study.
Drink a glass of water first, avoid a big meal and hot rooms before a class, and ask your GP or pharmacist if a medicine could be the cause. Never stop or change a medicine yourself.
The NHS lists "lightheadedness or dizziness", "feeling sick", "blurred vision", "generally feeling weak", "confusion" and "fainting". "It may be low because you're fit and healthy, or you may have inherited it from your parents."
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Blood pools in your legs and tummy, and your body has to push it back up. Low blood pressure on standing (orthostatic or postural hypotension) is a fall of at least 20 in the top number or 10 in the bottom number within 3 minutes. A short, bigger drop in the first 15 seconds is common in older adults: 29% in 13 studies. The lasting kind affected 22% of people over 60 living at home.
The NHS lists pregnancy, conditions such as diabetes, and some medicines. In 69 trials, beta blockers and tricyclic antidepressants were most linked with it. Blood pressure falls after meals in about 4 in 10 older adults, symptoms are "most likely to occur in the morning and after meals", and heat lowers how well you cope with standing.
Low blood pressure on standing went with more falls across 50 studies, the World Falls Guidelines call it the most common heart and circulation cause of falls, and the NHS lists low blood pressure among the causes of falls. Long-term studies also link it with later dementia, which doesn't show cause.
In PoTS the heart races when you stand, usually without a fall in blood pressure: our Pilates for PoTS guide covers it. Vertigo is a spinning feeling, usually from the inner ear: our Pilates for vertigo guide covers spinning and feeling dizzy after a class.
Most of a mat class is lying, side-lying and on all fours, where blood pressure holds up well. The risky moments are changes of position: rolling up from lying to sitting (the roll-up, teaser and wall roll-up), coming back up after your head has been below your heart (the roll-over, jack knife and standing roll-downs), and getting up off the mat at the end. Hot classes add heat; the reformer adds stepping off a moving carriage (our reading).
Our searches of PubMed and ClinicalTrials.gov in November 2026 screened 192 records on Pilates and blood pressure: none measured blood pressure on standing, dizziness or fainting, and no trial recruited people with low blood pressure, postural hypotension or fainting.
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In 13 adults with high blood pressure, one session lowered blood pressure by about 5 to 8 mmHg over the next hour, measured lying down. In 16 women with normal blood pressure, a mat session lowered it no more than resting did, and a reformer session in 17 older adults didn't change it. In 10 practitioners, the top number rose about 7 mmHg straight after a class and was back to normal within 5 minutes. Over 12 weeks, mat Pilates lowered resting blood pressure in 47 women, including those with normal readings, in a study without a non-exercise group.
Across 65 studies, blood pressure was about 5/3 mmHg lower after a session. A review estimates that between 50% and 80% of healthy people would start to feel faint if tilted upright and kept still for 15 minutes straight after exercise, because still legs stop pumping blood back up. Moving the legs helps.
In 223 people with fainting that came with warning signs, learning to cross the legs and tense the muscles cut repeat faints from 50.9% to 31.6% over about 14 months, with no side effects. The rise in blood pressure starts within 3 to 5 seconds. Heart rhythm experts call the moves risk-free, but they don't help people who get little or no warning.
In 42 people aged 65 and over, 10 leg pushes against a band while lying reduced the drop in blood pressure on standing; in 13 people, tensing the lower body while rising raised the lowest pressure. Both were small studies done outside Pilates. Blood Pressure UK suggests bending and straightening your legs before you stand, and Parkinson's UK pumping your feet 10 times.
About half a litre of water raised standing blood pressure within half an hour in older adults and in people whose blood pressure control is damaged, but not in young people. Check first if you have a heart condition or a daily fluid limit.
Leg and tummy compression bandages kept 90% of 21 older people free of symptoms on a tilt table, against 53% with sham bandages, and an expert consensus says waist-high garments work best and knee-high stockings don't. The NHS lists support stockings among a GP's options; Blood Pressure UK says to ask your GP first.
In small studies of older adults with postural hypotension, strength training made legs stronger without changing the fall in blood pressure. Experts suggest exercise that isn't upright, such as a recumbent bike, rowing or swimming, being well hydrated, and care when standing afterwards. Mat Pilates is mostly not upright; the getting up is the part to manage (our reading).
These are our Pilates for PoTS guide's steps, word for word. The NHS says to move slowly from lying to sitting to standing.
See the movement on the 3D figure: Get up and down from the floor
These changes are our suggestions, from the NHS's advice not to bend down or change posture suddenly.
The roll-up, teaser and wall roll-up take you from lying to sitting in one go. While you get symptoms, leave them out or roll to your side and push up instead. The roll-up's own caution already says to roll onto your side if you feel dizzy, sick or unwell.
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The roll-over and jack knife put your head below your heart and bring it back up; leave them out while you get symptoms. Swap standing roll-downs for a seated forward reach with your head no lower than your heart.
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Keep your legs working in standing work, with calf raises or marching, rather than standing still. The NHS says not to sit or stand for long periods.
Keep breathing easily, with no breath holds or fast breathing. If lateral breathing makes you light-headed, make the breaths smaller, as its own caution says.
Skip hot classes while you get symptoms: heat lowers how well you cope with standing, and experts advise avoiding exercise in heat.
Finish the lying footwork, roll to your side, sit on the carriage for a minute, and stand up holding the frame. Tell the teacher, so they don't hurry you off the machine (our suggestion).
Do all your lying work together. Ankle circles: 10 pumps, then 5 circles each way (adapted from the move page's dose). Heel slide: 8 each side (adapted from the move page's dose). Knee fold: 6 each side (adapted from the move page's dose). Pelvic tilt into bridge: 8 slow reps, breathing out as you lift; dead bug heel taps: 6 each side (our PoTS and high blood pressure classes' starting points). Single-leg circle: "5 circles each direction, each leg" (the move page's dose), small.
3D demoAnkle circlesBeginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoDead bug heel tapsBeginner · No equipmentAll fours is the step before kneeling and standing in the NHS's getting-up steps. Clamshell: 10 each side; bird dog: 5 each side (our classes' editorial starting points). Side kick: "8 to 10 each side" (the move page's dose).
Seated march: "1 to 2 minutes as a warm-up" (the move page's dose). Seated calf raise: 15 before every stand; sit to stand: 5 slow, squeezing your thighs and buttocks as you rise; standing march: 1 minute (our yoga for low blood pressure class's doses). Slow calf raise: 2 sets of 10, holding a counter (our diabetes class's dose). Wall side leg lift: "10 to 12 each side" (the move page's dose).
3D demoSeated marchBeginner · A bench or box
3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box
3D demoSit to stand, pushing on the thighsBeginner · A bench or box
3D demoSlow calf raiseBeginner · A wall
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoStanding marchBeginner · No equipmentLie down and raise your legs until you feel better. If you can't lie down, sit, if possible with your head lowered between your knees, and drink some water.
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Cross one leg in front of the other while standing, then tense your leg muscles and clench your buttock and tummy muscles. You can also rock up and down on your toes, or clench your fists. Keep breathing while you hold the squeeze, sit or lie down as soon as you can, and practise when you're well so the moves come quickly (our suggestions).
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).
If you feel faint, stop, lie down and raise your legs. Use the counter-manoeuvres if you can't lie down.
Drink a glass of water, and don't practise straight after a big meal: the NHS advises drinking more water and eating small, frequent meals (our suggestion for a class). With a heart condition or a daily fluid limit, check with your doctor before drinking more.
Symptoms are often worst in the morning and after meals, so choose a time when you feel steadiest (our suggestion).
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Don't add salt unless your doctor advises it (our suggestion, as our PoTS and yoga guides say).
Our 25-minute class gets you down to the floor once and up once, works your legs before every stand and ends sitting. No trial has tested it: its order is our editorial choice, from the NHS's advice and small studies of leg pumping and muscle tensing done outside Pilates. If your heart races when you stand, the PoTS class never stands; the vertigo class never lies down.
A 25-minute Pilates class for low blood pressure: one block of floor work, legs working before every stand, getting up in stages, and a seated finish.
25 minBeginner17 movesA bench or box, A wallA 25-minute head-up yoga class for low blood pressure: leg pumps lying and sitting, a squeeze as you stand, and standing poses at a counter.
25 minBeginner17 movesA bench or box, A wallA 20-minute floor Pilates class for PoTS (POTS): breathing, leg strength and core work lying down and on your side, then legs up the wall, with no standing.
20 minBeginner14 movesOther / check instructions, A wallA 20-minute Pilates class that never lies down, rolls or tips your head down: Pilates breathing and spine work in a chair, then legs and balance at a counter.
20 minBeginner16 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 15-minute chair Pilates class done entirely sitting down, in a chair or wheelchair: breathing, spine moves, and leg and arm strength with water bottles.
15 minBeginner13 movesA bench or box, Something with weightA 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 movesA wall, A bench or boxThe NHS low blood pressure page has only a see-a-GP box, so the fainting lines come from our Pilates for PoTS guide and the blood pressure lines from our Pilates for high blood pressure guide, word for word. 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.
Call 999 if someone has any of these, and don't drive yourself to A&E:
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Call 999 if:
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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Call 999 if someone has hit their head and has been knocked out and hasn't woken up, can't stay awake or keep their eyes open, has a fit, has fallen from a height of more than 1 metre or 5 stairs, has problems with their vision or hearing, has clear fluid coming from their ears or nose, has new numbness or weakness, has problems with walking, balance, understanding, speaking or writing, hit their head at high speed, or their behaviour has changed. Get help from NHS 111 if they're being sick, feel dizzy or take medicine that thins the blood. If you're told to go to A&E (accident and emergency), don't drive yourself there if you have hit your head.
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Dizziness or light-headedness when you stand up or change position can be a drop in blood pressure (postural hypotension), not vertigo. Get up slowly, from lying to sitting to standing, and see a GP if you keep getting dizzy or fainting. Our exercise for PoTS guide covers postural tachycardia syndrome.
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Never stop or change a medicine yourself; tell your GP or pharmacist, who can check your blood pressure lying and standing (our suggestion). The NHS: "You must tell the Driver and Vehicle Licensing Agency (DVLA) if you're fainting regularly as it could affect your ability to drive."
In pregnancy, after the first trimester, keep time flat on your back to a few minutes: prop your upper body up, or use a side-lying or all-fours version.
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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Naturally low blood pressure without symptoms usually is, but symptoms on standing need checking: they go with more falls and can come from medicines or conditions that need treating. Fainting at all needs a GP check.
No trial has tested it, and blood pressure tends to be a little lower after a session, not higher.
Strength rose without any change in the drop in small trials. Using your leg and tummy muscles at the moment you stand is what helps.
No study has tested head-down moves for low blood pressure, and coming back up from them is a change of position, the moment the NHS warns about. That agrees with our yoga for low blood pressure guide.
It's a good way to stay strong and steady, but it doesn't treat low blood pressure, and no trial has tested it. If your blood pressure is naturally low and you feel well, it doesn't need raising. The point is to set up your class so you don't feel faint when you get up.
Yes, with the changes on this page: legs working before you stand, getting up in stages, no fast roll-ups or head-down moves while you get symptoms, a drink beforehand and a cool room. If you've fainted, see a GP first.
Usually it's blood pressure dropping as you stand up after lying down, made worse by heat, not drinking enough or a big meal; blood pressure also stays a little lower for a while after any exercise. If the room spins, see our Pilates for vertigo guide, and if it keeps happening, see a GP.
A little, for an hour or so after a session, as other exercise does; the studies are in people with normal or high blood pressure, and our Pilates for high blood pressure guide covers them. It isn't a reason to avoid Pilates, but it is a reason to get up slowly at the end.
While you get symptoms, leave out or slow down the moves that take you from lying to sitting in one go, like the roll-up and teaser, and those that put your head below your heart and bring it back up, like the roll-over and jack knife. Everything else is fine with the getting-up steps.
Lie down and raise your legs until you feel better. If you can't, sit with your head between your knees, or cross your legs and squeeze your leg, buttock and tummy muscles. Call 999 if someone faints while exercising or can't be woken within a minute.
We'd avoid it while you get symptoms: heat lowers how well you cope with standing. If you do go, drink beforehand, leave the room if you feel dizzy or sick, and get up slowly.
Yes, with the same rules: finish the lying work, roll to your side, sit on the carriage for a minute and stand up holding the frame. Tell the teacher, so they don't hurry you.
A glass of water beforehand is sensible: about half a litre raised standing blood pressure within half an hour in older adults. Don't add salt unless your doctor advises it, and check before drinking more if you have a heart condition or a fluid limit.
Yes, with the same changes, a chair or counter near you, and someone nearby if you've fallen. If it comes from Parkinson's, diabetes or a medicine, your doctor and the matching guide come first.
In low blood pressure on standing, the pressure falls; in PoTS, the heart races without that fall; vertigo is a spinning feeling, usually from the inner ear. Our Pilates for PoTS and Pilates for vertigo guides cover those.
Exercise that isn't upright, such as a recumbent bike, rowing or swimming, is the expert advice, with fluids first and care when standing afterwards. Strength training is good for you but hasn't been shown to correct the drop.
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.
