Pilates guide
Pilates can suit lupus (systemic lupus erythematosus, or SLE) well: it's low impact, easy to adapt for sore joints and tired days, and the charity LUPUS UK says it can help with posture, balance and co-ordination. Exercise doesn't make lupus more active, and in trials it eased tiredness and low mood a little. But Pilates itself has barely been tested in lupus, and it's the strength and flexibility part of your week, not the cardio.
Pilates sits beside your rheumatology team and your lupus medicines, never in place of them. This guide covers where it fits alongside walking, cycling or swimming, how to protect sore hands and joints, what to do in a flare, steroids and your bones, hip or groin pain, sun and fluorescent light, Raynaud's, and the warning signs that need urgent help, with a 30-minute class that keeps weight off your hands and 3D demos of every move.
An international task force recommends physical activity for everyone with lupus, after a medical check if needed, and the British Society for Rheumatology (BSR) and the European Alliance of Associations for Rheumatology (EULAR) say exercise should be encouraged as your lupus allows.
In a Cochrane review of 13 studies, exercise probably made no difference to how active lupus was. A 2026 review of 12 trials found small to moderate gains in tiredness, everyday function, mood and pain.
One small online trial found Pilates twice a week improved mood and resilience after 8 weeks, but few people made most classes. Two other trials mixed Pilates with running or a diet. LUPUS UK says yoga, Pilates and tai chi "can help with posture, balance and co-ordination".
The task force asks for 3 to 5 sessions a week combining aerobic and strength exercise, building to 150 to 300 minutes of moderate activity a week. Pilates can be 1 or 2 of the strength sessions, alongside walking, cycling or swimming.
In a joint flare, keep inflamed joints out of loaded moves but keep them moving gently. Lupus most often affects the small joints of the hands, so choose versions with no weight on your hands. If you take steroids, use head-down curls and avoid deep, loaded forward bending.
Groin or hip pain needs a doctor before you carry on, especially if you take steroids. Sharp chest pain that's worse when you breathe in, sudden breathlessness or a painful, swollen leg need urgent help.
Lupus is a long-term autoimmune condition, where the immune system attacks healthy tissue. The NHS says it "causes joint pain, skin rashes and tiredness", and it flares up for a few weeks or longer and then settles. More severe lupus can inflame the lungs, heart and kidneys. Around 1 in 1,000 adults in the UK have it, and women are about nine times as likely to have it as men. Treatment includes hydroxychloroquine, steroids kept to the lowest dose, and other medicines that calm the immune system.
Joint pain is the commonest feature of lupus, affecting up to 95% of people. Arthritis UK says it's common "especially in the small joints of the hands and feet" and often moves from joint to joint. Most lupus arthritis doesn't deform the joints; in a cohort of 2,264 people, 55% had arthritis, and about 1 in 5 of those had Jaccoud's arthropathy, where joints change shape but can be pushed back. Other studies put Jaccoud's at about 5% of people with lupus.
Tendons tearing without an injury is rare in lupus (55 cases reported worldwide), mostly the kneecap and Achilles tendons, and almost always in people taking steroids. Muscle inflammation (myositis) is uncommon; LUPUS UK says exercise helps build muscle strength back. So build load gradually (our reading).
One study found bendy (hypermobile) joints in 48% of people with lupus against 15% of people without it; another found no difference. Arthritis UK says a small number of people with lupus have hypermobility. If your joints are bendy, work in the middle of your range, as our Pilates for hypermobility guide says.
Fatigue is the commonest symptom: 81% of 120 UK outpatients had abnormal tiredness, and studies report 67% to 90%. Pain, low mood and inactivity all add to it. In 100 people wearing activity monitors, only 11 met the activity guidelines.
The NHS lists high-dose steroid tablets for more than 3 months as a risk for osteoporosis. People with lupus break bones about twice as often as people without it, including the hip and spine, and LUPUS UK says osteoporosis is about five times as common in lupus.
In avascular necrosis (also called osteonecrosis), part of a bone loses its blood supply, most often at the hip. About 9% of people with lupus have it with symptoms, and more have it silently on scans; high-dose steroids and active lupus make it more likely. The first sign is usually bone pain that limits movement and is worse with weight-bearing. Arthritis UK: "If you have pain in your groin, you should see your doctor".
Ultraviolet (UV) light can trigger lupus flares in the skin and the rest of the body. Studies report that 23% to 83% of people with lupus react to UV, and a reaction can come up to 3 weeks later, with tiredness and joint pain. The NHS also advises not spending a lot of time in rooms with fluorescent lights.
People with lupus have about 3 times the risk of a heart attack and 2.5 times the risk of a stroke, so regular exercise is part of protecting your heart. Lupus can inflame the lining of the heart (pericarditis) or lungs (pleurisy), and antiphospholipid syndrome, which is more common with lupus, makes blood clot more easily.
About 1 in 3 people with lupus have depression and about 1 in 4 anxiety. About 1 in 6 also have fibromyalgia, where pacing and a slow build-up matter most (our Pilates for fibromyalgia guide).
17 experts and 2 people with lupus agreed that physical activity "is recommended in all persons" with lupus, after a medical check if needed. For inactive or mildly active lupus: build gradually to 150 to 300 minutes a week of moderate activity, with strength work on at least 2 days; 3 to 5 sessions a week combining aerobic and strength exercise; strength work as 1 to 3 sets of 8 to 12; and every session starting with a warm-up and ending with a cool-down "including stretching". It doesn't mention Pilates, yoga or tai chi.
Source 4
"Physical activity should be encouraged as appropriate to disease status", with tailored advice for some people. The guideline lists balance and flexibility exercise, such as yoga, tai chi or stretching, as one type of exercise, alongside aerobic and strength exercise.
Source 5
People with lupus "should be offered education and support for physical exercise, smoking cessation and avoidance of cold exposure", and sun protection is important. The evidence review behind this found 34 exercise studies in lupus and none of Pilates, yoga or tai chi. Exercise adds to lupus medicines; it never replaces them.
The NHS says pace yourself and "try to stay active, even on a bad day". Arthritis UK says "Even when you're having a flare-up, a small amount of exercise is helpful". LUPUS UK says "Yoga, Pilates and Tai Chi can help with posture, balance and co-ordination", that regular lower-intensity exercise beats occasional hard sessions, and to check with your doctor first because "some movements can be harmful when you have swollen joints or muscle pain".
An older LUPUS UK factsheet (last reviewed in 2017) says jogging "should be avoided". The 2024 task force and Arthritis UK don't restrict it, and Arthritis UK suggests walking or jogging to keep bones strong. What suits you depends on your joints, your hips and your fitness.
In the Cochrane review (13 studies, 540 people, programmes of up to 12 weeks), exercise probably made little or no difference to how active lupus was (moderate certainty), and "No studies reported any serious side effects that were related to the exercise programme", though harms were poorly reported. A 2026 review of 12 trials also found no change in lupus activity.
The 2026 review of 12 trials with 470 people found small to moderate improvements in tiredness, everyday function, fitness, low mood and pain, with moderate certainty, best with moderate-intensity programmes of 8 to 12 weeks. The earlier Cochrane review rated the tiredness benefit as small and low certainty, and an umbrella review notes the estimates rest on the same few small trials. So the evidence is getting firmer, but it's still small trials.
In 93 people without active major-organ lupus, 12 weeks of walking, cycling or swimming for 30 to 50 minutes 3 times a week left 49% feeling "much" or "very much" better, against 28% who did relaxation and 16% who did neither.
Source 44
High-intensity interval training raised fitness in 53 people with lupus but didn't change tiredness. In 80 people with lupus and osteoporosis, strength training with or without aerobic exercise raised bone density over 6 months.
Reviews of 11 studies (469 people) and 40 studies (2,291 people) found exercise safe, with rare side effects and no severe ones. Most trials were in people with inactive or mildly active lupus.
In a UK feasibility trial, 31 people with lupus were offered live online Pilates classes, 50 minutes twice a week for 8 weeks, adapted for each person. After 8 weeks their mood and resilience scores were better than a comparison group's; by 6 months only resilience was still better. Only 55% came to more than half the classes, 15% sometimes felt physically worse after a class, and some found a morning class too early for their stiffness. The trial was too small to show whether Pilates works.
Source 9
In one sample of 19 women with lupus, reported in two papers, 8 weeks of cycling, running and 20 minutes of Pilates 3 times a week improved fitness, flexibility and tiredness scores against no exercise; Pilates' share can't be separated out. In a trial of 64 obese women with lupus, both groups did Pilates and a diet, so it tested laser acupuncture, not Pilates.
A Turkish trial of clinical Pilates for tiredness in women with lupus has no results yet, and a 2026 review of Pilates in rheumatic diseases found only these few lupus studies. We found no trial of yoga or tai chi in lupus either.
Hydroxychloroquine, steroids at the lowest dose and other lupus medicines treat the disease; exercise is an addition. Never stop or change a medicine because of exercise.
Ask your doctor before an exercise programme, especially with heart, lung or kidney involvement, osteonecrosis, joints changed in shape by lupus, blood thinners or very low platelets.
Source 4
The task force asks for a specialist's review before you start if you have osteonecrosis or Jaccoud's arthropathy, and caution with activities where you could be knocked or fall if you take blood thinners.
Source 4
Check again with your team: inflammation of the heart, the lining of the lungs or the muscles is a reason to pause exercise until you're cleared. In a joint flare, leave the inflamed joints out of loaded moves but keep them moving gently.
Source 4
Walking, cycling, swimming or a cross-trainer, building from 20 to 30 minutes towards 50, at an effort of about 5 or 6 out of 10, on 3 to 5 days a week, towards 150 to 300 minutes a week. Pilates doesn't count towards this.
Pilates mat work plus standing moves such as sit to stand and calf raises can be one or both strength sessions. If steroids have weakened your muscles, a 2026 review says progressive strength training is the first approach, 2 or 3 times a week, so add bands or weights as you're able; our exercise for lupus guide has gym and home strength moves.
The task force asks for a gentle warm-up and a cool-down with stretching in every session. A short, gentle Pilates sequence makes a good cool-down after a walk or a cycle (our suggestion).
Source 4
LUPUS UK names posture, balance and co-ordination as what Pilates can help with. Balance matters more if steroids have thinned your bones: do balance moves next to a counter.
Source 13
Our editorial starting point, after a check with your rheumatology team: 1 Pilates class a week of 20 to 30 minutes, plus 10 to 15 minutes of walking or cycling on 3 days. Every 2 weeks without a flare, add 5 minutes of walking or a second Pilates session, aiming over about 3 months for 2 Pilates or strength sessions and 150 minutes of aerobic activity a week.
The NHS says "learn to pace yourself to avoid getting too tired" and "try to stay active, even on a bad day". LUPUS UK says regular, lower-intensity exercise is better than occasional hard sessions.
Plan the same amount on good and bad days, use the class's stop point when you're tired, and choose a time of day after morning stiffness has eased; some people in the online Pilates trial found a 9.30am class too early. On a bad day, a short chair or lying-down session is better than nothing (our suggestion).
Source 9
If small efforts are regularly followed, hours or days later, by a crash out of proportion to what you did, see a GP, as our exercise for lupus guide says; building up gradually isn't the right approach for that.
The task force advises keeping inflamed joints out of loaded exercise but keeping them moving below the pain threshold. Arthritis UK says a small amount of exercise is helpful even in a flare. Swap to moves that leave the sore joint out, lying, side-lying or seated, and keep gentle range of movement for it.
The small hand joints are the ones lupus most often affects, so when your hands are sore, leave out moves that put weight through them (the knee hover, planks, leg pull, Pilates push-up and all-fours moves) or do them on your forearms (our suggestion, matching the move pages' wrist cautions). With Jaccoud's arthropathy, see a specialist before loading your hands.
Our hand tendon glides suit stiff fingers: they were tested as part of hand programmes in other conditions, not in lupus, as the move's page says.
The flare moves from our exercise for lupus guide: 5 to 10 slow repetitions within a comfortable range, once or twice a day, keeping inflamed joints moving gently. Add a few lateral breaths.
3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment
3D demoWrist & forearm flowBeginner · No equipment
3D demoPendulum exercise (Codman's pendulum)Beginner · A bench or box
3D demoTable slide (seated forward reach)Beginner · A bench or box
3D demoSupine heel slideBeginner · No equipment
3D demoQuad set (static quads)Beginner · No equipment
3D demoAnkle CARs (controlled articular rotations)Beginner · No equipment
3D demoLateral breathing (Pilates breathing)Beginner · No equipmentIf steroids have thinned your bones, use our osteoporosis cautions: head-down versions of curl-ups, alternatives to the roll-up and roll-down, and smooth, comfortable twists only. A 2026 review of exercise with steroids advises "spine-sparing techniques that avoid high-risk actions such as deep forward spinal flexion", and strength plus balance work 2 or 3 times a week with extra work for the back muscles. Pilates back-extension moves such as the swan fit that (our reading).
Arthritis UK says weight-bearing exercise such as walking or jogging helps keep bones strong, and in one trial strength training raised bone density in people with lupus and osteoporosis. Pilates on a mat is light on bone, so add standing and weight-bearing moves (our reading).
New groin or hip pain that's worse when you put weight on it needs a doctor before you carry on with impact, one-leg work or deep hip bends: it can be avascular necrosis. With known avascular necrosis, see a specialist first; cycling, swimming and upper-body and trunk work are the usual choices while a hip is assessed (our suggestion).
Holding your breath while straining raises blood pressure, which steroids can already raise. Pilates' steady breathing suits this; our Pilates for high blood pressure guide has more.
Source 17
Never stop or change hydroxychloroquine, steroids or other medicines because of exercise or a flare without your team. If you've taken steroids for more than 3 weeks or at a high dose, they usually need to be reduced gradually.
Source 53
The NHS says to "use high-factor (at least factor 50) sunscreen and wear a hat in the sun", and you can get sunscreen on prescription if you have lupus. In the UK the sun is strongest between 11am and 3pm from March to October; reapply sunscreen every 2 hours and after sweating. Cover up, and avoid the most UV-exposed hours where you can.
The NHS also advises not spending a lot of time in rooms with fluorescent lights. If studio lighting bothers your skin, ask about it, or cover up (our suggestion).
Source 1
With Raynaud's, keep your hands and feet warm, avoid cold floors and surfaces, and dry your skin during and after exercise. The NHS says regular exercise helps circulation. A warm room, socks and a blanket for floor work help (our suggestion).
Standing march, 2 minutes at an easy pace (our Pilates for diabetes class); shoulder rolls, 10 to 15 slow circles each way (the move's page); hand tendon glides, 5 of each position held for 5 seconds (our arthritis class); lateral breathing, 5 to 8 breaths (the move's page).
Single-leg stand, 2 holds of 20 to 30 seconds each leg with a hand on the counter (our editorial start, building to our skiers class's 30 seconds); wall side leg lift, 10 each side (our Pilates classes).
Sit to stand, 2 sets of 10 with your hands across your chest (our Pilates for diabetes class, within the task force's 1 to 3 sets of 8 to 12); slow calf raise, 10, holding the counter (our Pilates classes).
Pelvic tilt into bridge, 8 (our fibromyalgia class); dead bug heel taps, 6 each side with your head down (our beginner class); side kick, 8 each side, and clamshell, 10 each side (our Pilates classes); swan, 5 small lifts with your arms by your sides, left out if arching hurts.
Hamstring stretch with a strap, 30 seconds each leg, and open book, 5 each side (our Pilates classes); slow breathing, 2 minutes (our fibromyalgia class), or at least 5 minutes on its own (the move's page).
Leave out the knee hover, leg pull, Pilates push-up, side bend, planks and all-fours moves such as cat-cow, or do forearm versions; with Jaccoud's arthropathy, see a specialist first.
Source 4
Leave out loaded rounding: the roll-up, roll-over, rolling like a ball and jack knife. Keep your head down in the hundred, chest lift, single-leg stretch and criss-cross, and twist and side-bend smoothly, as the move pages say.
Source 17
Leave out single-leg circles, one-leg balance and deep hip bends until a specialist has advised (our suggestion).
Avoid falls and knocks: balance work next to a counter, and no jumping on a reformer (our suggestion, from the task force's caution).
Source 4
Work in the middle of your range, as the move pages say.
Start with our 30-minute class for lupus, which keeps weight off your hands. The arthritis and osteoporosis classes suit sore joints and thin bones, the chair classes suit flare or very tired days, and the cardio and strength workouts make up the rest of the task force's week.
A 30-minute Pilates class for lupus with no weight on your hands: a gentle warm-up, balance at a counter, standing and mat strength, and a stretching cool-down.
30 minBeginner16 movesA wall, A bench or boxA gentle 25-minute Pilates class for arthritis: lying, side-lying, chair and standing moves, with no kneeling or weight on your hands, and flare-day options.
25 minBeginner16 movesA bench or box, Something with weightA 25-minute Pilates workout for osteoporosis and osteopenia: the Royal Osteoporosis Society's swaps for rounding moves, plus back strength and balance.
25 minBeginner16 movesA wall, A bench or boxA 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 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 20-minute Pilates class for fibromyalgia, built on the trial programmes: 8 of each move, a stop point for bad days, and rest to finish.
20 minBeginner13 movesNo equipmentA 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 machineA 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 boxA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA full-body resistance band workout: squats, rows, push-ups, presses, pull-aparts, band walks, good mornings and flyes.
30 minBeginner9 movesA band, An anchor pointImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsA slow 15-minute Pilates wind-down for the last hour before bed: slow breathing, small lying moves and a few minutes of stillness, with no effort or holds.
15 minBeginner9 movesFirm cushionNo trial has tested Pilates across autoimmune conditions. Our condition guides cover the ones with Pilates or exercise research.
These match our exercise for lupus guide. In the US, call 911 where this page says 999.
Call 999 if:
Hip, groin, buttock or thigh pain for more than 6 weeks with a normal X-ray, or new hip pain with a risk factor (avascular necrosis in the other hip, drinking a lot of alcohol, high-dose or repeated steroids, medicines that dampen the immune system, chemotherapy, sickle cell disease or another blood clotting disorder, HIV (human immunodeficiency virus), or a recent pregnancy): ask your GP about an MRI scan and a referral to a hip specialist.
Leave out impact and deep hip bends until it's been checked.
Ask your doctor before an exercise programme, especially with heart, lung or kidney involvement, osteonecrosis, joints changed in shape by lupus, blood thinners or very low platelets.
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.
Never stop or change hydroxychloroquine, steroids or other medicines because of exercise or a flare without your team. If you've taken steroids for more than 3 weeks or at a high dose, they usually need to be reduced gradually.
Source 53
Low mood and anxiety are common with lupus; tell your team, as talking therapies can help.
If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E. For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988.
In trials, exercise made little or no difference to how active lupus was, and no serious side effects linked to exercise were reported. The trials were mostly in people with inactive or mild lupus, which is why a medical check comes first.
Exercise hasn't been shown to change lupus activity or inflammation, and no Pilates study has measured it. Pilates may help strength, balance, mood and tiredness a little, which is reason enough.
The task force recommends aerobic and strength exercise together, 3 to 5 sessions a week; the NHS doesn't count Pilates as aerobic activity.
The NHS says try to stay active, even on a bad day, and exercise eased tiredness a little in trials. Pacing balances rest and activity.
The only Pilates trial in lupus used online mat classes adapted for each person. A small, well-taught mat or chair class is enough.
Most lupus arthritis doesn't deform the joints. Keep inflamed joints moving gently and work the others; new joint pain, groin pain or a hot, swollen joint still need checking.
Mostly, but the NHS also advises against spending a lot of time in rooms with fluorescent lights.
Source 1
It can be a good part of your exercise: it's low impact, easy to adapt, and LUPUS UK says it can help with posture, balance and co-ordination. It has barely been tested in lupus: in one small online trial, mood improved after 8 weeks, though few people made most classes. Exercise in general doesn't make lupus more active and eases tiredness a little.
Yes, for most people, after a check with your rheumatology team, especially if lupus has affected your heart, lungs or kidneys, you have avascular necrosis or joints changed in shape, or you take blood thinners. Start gently and tell your teacher about your lupus.
It can be, but you don't need it. The springs can lighten or add load, which suits some people, but the only Pilates trial in lupus used mat classes online. Skip jumping on a reformer if you take blood thinners or have thin bones (our suggestion).
Once or twice a week as your strength work, with walking, cycling or swimming on other days, building towards 150 minutes of moderate activity a week. The online trial used two 50-minute classes a week for 8 weeks; start shorter if you're tired.
Check with your team first: a flare that affects your heart, lungs or muscles can need a pause. If it's mainly your joints, leave the inflamed joints out and keep them gently moving; a short lying-down or chair session is often fine.
Exercise in general eases lupus tiredness a little, and the evidence for that is getting firmer. Pilates on its own hasn't been tested well enough to say. Pace yourself: the same planned amount on good and bad days, and stop early on bad days.
There's no evidence that exercise changes lupus activity or inflammation. Exercise helps fitness, strength, mood and tiredness; your medicines treat the lupus.
Avoid putting weight on sore hands or wrists, such as planks and all-fours moves; loaded rolling and deep forward bending if steroids have thinned your bones; and deep hip bends or impact if you have hip or groin pain. Our moves section shows the swaps.
Yes, with bone-safe versions: keep your head down in curl-ups and skip loaded rolling moves. Add weight-bearing and strength exercise, which helps bones. If you have osteoporosis, our Pilates for osteoporosis guide has more.
See your doctor before carrying on with impact or deep hip work. Groin pain can be a sign of avascular necrosis, which steroids make more likely.
Outdoors, avoid the strongest sun (11am to 3pm from March to October in the UK), cover up and use factor 50 sunscreen, which you can get on prescription. The NHS also advises not spending a lot of time in rooms with fluorescent lights.
It hasn't been tested across autoimmune diseases as a group. Our guides for rheumatoid arthritis, ankylosing spondylitis and multiple sclerosis cover Pilates for those conditions.
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.
