Pilates guide
Pilates is safe with lymphoedema (lymphedema in the US), or if you're at risk of it after cancer treatment: the National Institute for Health and Care Excellence (NICE) says physical activity doesn't cause or worsen it, and slowly built-up weight lifting didn't increase arm swelling in trials. The small Pilates trials, mostly in women after breast cancer, disagree on whether Pilates changes swelling, and they were short and at high risk of bias, so expect better strength, movement and comfort rather than a smaller limb.
Pilates sits beside compression, skin care and your lymphoedema team, never in place of them.
This guide covers what lymphoedema is and how lymph moves, what the trials show, compression during exercise, how to build up your arm or leg the way the Physical Activity and Lymphedema (PAL) trial did, which Pilates moves to change, leg lymphoedema, the "lymphatic drainage" claims, cellulitis and clots, and a 25-minute moving class with arm and leg options.
NICE says "there is no indication that physical activity causes, or worsens, lymphoedema". In the PAL trials, slowly built-up weight lifting didn't increase arm swelling in women who had lymphoedema, and didn't bring it on in women at risk.
The British Lymphology Society recommends "Yoga and pilates" wherever your swelling is, and Cancer Research UK lists Pilates among good activities. Tell your teacher about your lymphoedema.
The small Pilates trials disagree on whether it changes swelling, and a 2026 overview calls the evidence "very uncertain". Compression is the first treatment for the swelling itself.
Macmillan advises swapping planks and other long holds for moving exercises. Build up the affected arm or leg the PAL way: start very light, and add a little each week only if the limb doesn't change.
The British Lymphology Society says it's "generally best" to wear a prescribed garment for activity, though trials found exercising without one didn't worsen swelling, so it's partly your choice.
Skin that is painful, hot and swollen can be cellulitis: ask for an urgent GP appointment or get help from NHS 111. The full list, including clots and new swelling after cancer treatment, is below.
"A long-term (chronic) condition that causes swelling in the body's tissues", usually in an arm or leg, the NHS says. At first the swelling may be soft, leave a dent when pressed, and come and go, worse at the end of the day; other signs are an aching, heavy feeling, difficulty moving, repeated skin infections, and hard or thickened skin. Breast Cancer Now says early swelling can be worse "after strenuous activities or in hot weather".
Primary lymphoedema comes from faulty genes. Secondary lymphoedema follows cancer treatment, infection, injury, inflammation or a lack of limb movement. After cancer, there's a particular risk wherever lymph glands are removed, such as for breast, head and neck, skin (melanoma), gynaecological, prostate and penile cancers, and lymphoma. More than 200,000 people in the UK are thought to have it.
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About 1 in 5 women develop arm lymphoedema after breast cancer, about four times more often after removal of the armpit lymph nodes than after a sentinel node biopsy. After gynaecological cancer, 37% to 45% of women had new leg lymphoedema within 2 years.
"The lymphatic system has no central pump, such as the heart", the NHS says: it relies on the massaging effect of the muscles around its vessels, which is why exercise matters. Deep breathing changes the pressure in your tummy and chest, which "encourages lymph to flow back into the blood system", Cancer Research UK says, and the British Lymphology Society says breathing exercises "may be as important as limb exercises".
The recommended treatment is decongestive lymphatic therapy: compression, skin care, exercise and specialist massage, first intensively, then as a daily routine. After breast cancer, NICE recommends compression as the first stage. Losing weight, if you're overweight, can help the swelling.
As muscle-pump exercise, breathing and strength built up slowly, as part of the whole-body activity the lymphoedema bodies recommend. It doesn't replace compression, skin care or your lymphoedema team.
NICE (2025) tells people at risk after breast cancer that "there is no indication that physical activity causes, or worsens, lymphoedema", and asks staff to reassure people who have it that there's no evidence that activity, including arm exercise, will make it worse. Across 36 studies, exercise didn't worsen swelling and improved pain, function, strength, tiredness and quality of life. A 2026 review of 17 studies found exercise lowered the chance of developing lymphoedema by about 30%, at low certainty.
In the PAL trial, 141 women with arm lymphoedema lifted weights, built up slowly, twice a week for a year in a fitted garment: 11% had a rise in swelling of 5% or more, against 12% of the comparison group, and flare-ups were less common (14% against 29%). In 154 women at risk, new lymphoedema developed in 11% of the lifters and 17% of the others. In another trial of 62 women, heavier weights caused no flare-ups.
In 60 women with arm lymphoedema, 8 weeks of supervised clinical Pilates reduced limb size more than a home exercise programme done alone; a preprint of 28 women and a Korean trial of 20 women using reformer and other equipment also reported less swelling. But in 69 women after breast surgery, 16 weeks of mat Pilates didn't change arm volume; in 68 women, water exercise reduced forearm and hand swelling slightly more than Pilates; and in a 15-woman study with no comparison group, arm volume went up. The trials were small and short, most compared supervised Pilates with unsupervised home exercise, and a 2026 overview rates the Pilates evidence "very uncertain".
In the trials, Pilates improved shoulder movement, strength, arm function and quality of life after breast cancer, about as much as other exercise. Added to decongestive therapy in 30 women, it improved fitness but not the feeling of heaviness. The gains faded within 6 to 12 months after classes stopped.
A 2026 preprint review of 4 Pilates trials (353 women) found no serious adverse events, and a 14-woman home Pilates pilot reported none. The 2026 overview warns that "the absence of reported harm should not be interpreted as definitive evidence of safety".
Across the reviews, swelling hardly changed with exercise while strength improved, by about 9 kg in the upper body and 23 kg in the lower body in pooled strength-training studies. Compression carries the evidence for the swelling itself.
We found no Pilates trial in leg lymphoedema. In 12 studies of exercise for leg lymphoedema (367 people), the benefits were small and the studies at high risk of bias. After gynaecological cancer, exercise didn't clearly change leg volume, and "the only complication" was cellulitis. Adding 4 weeks of exercise to decongestive therapy improved strength without increasing swelling in 40 women, but in a 10-person weight-lifting pilot, 2 people had cellulitis in the first 2 months.
In UK PROSPER (392 women at high risk), physiotherapy-led exercise from 7 to 10 days after surgery, with bands from a month, improved arm function at a year with "No increase in complications, lymphoedema, or adverse events". Teams pace overhead arm work in the first week, and NICE asks breast units to teach arm exercises before treatment.
In 25 women, an upper-body strength session without compression didn't worsen swelling compared with the same session in a garment, and in a 12-week trial of 41 women, wearing one made no difference. In 31 women, the arm swelled a little straight after light exercise with or without a sleeve, and was back to normal within 24 hours.
The British Lymphology Society says it's "generally best" to wear a prescribed garment for activity, though some people manage with less; the Lymphoedema Support Network says always wear it. The International Society of Lymphology and an international exercise roundtable say no benefit or harm has been shown, so it's an individual decision.
Wear your garment for Pilates if you've been given one, unless your lymphoedema team says otherwise. You don't need it in the pool.
Arm exercises "started with no weight or one pound weights", and if there were no changes in symptoms by the next week, the weight went up by half a pound to a pound. If symptoms appeared or worsened, that exercise was skipped or done lighter until they settled, and after 2 or more missed sessions people dropped back. The first 13 weeks were supervised. Each session also included 5 to 15 minutes of deep tummy and back muscle work.
Use the same rule for bands, springs, hand weights and weight on your hands: start with 1 set of 8 to 10 at the lightest setting, and add a set, or a slightly stronger band or spring, only after a week or two with no change in your limb (our suggestion, from the PAL protocol). Build up the affected arm or leg slowly, as Macmillan advises.
If it "swells, aches, feels hotter or takes longer to recover than the other limbs afterwards", the Lymphoedema Support Network says, adapt or reduce what you're doing. The British Lymphology Society says swelling may look worse for a short while after activity, but should settle; if it doesn't, do less and ask your therapist.
The International Society of Lymphology suggests working towards at least 150 minutes a week of moderate, mixed aerobic and strength activity. Pilates is one part of that; add walking, cycling or swimming.
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Our suggestion, from the PAL trial's protocol (Schmitz 2009), which started with no weight or one-pound weights and added a little each week only if symptoms didn't change.
See the movement on the 3D figure: Band row
Leg swelling can follow treatment for gynaecological, prostate and penile cancer, melanoma and lymphoma. Too little activity was one of the risk factors after gynaecological cancer.
Use the leg moves below, especially ankle pumps and knee folds, and rest with your legs raised. Cancer Research UK suggests leg exercises "at least twice a day" and not sitting with your legs down. There's no Pilates trial in leg lymphoedema, so build up slowly.
Cellulitis was the main problem in leg exercise studies, so check your skin, avoid straps or bands that dig in, and keep the skin moisturised and protected, as your team advises.
Muscles squeeze the lymph vessels, and breathing changes the pressure in your chest, so walking, Pilates and other movement all help lymph flow. No study shows a Pilates routine sold for "lymphatic drainage" drains lymph better than walking, and none has measured "toxins".
Swelling has other causes besides lymphoedema. See a GP about "Swollen legs, ankles or feet that haven't improved after a few days, or symptoms of lipoedema." Our yoga for lymphatic drainage and lymphatic drainage massage guides cover the claims in more detail.
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Lipoedema is a build-up of fat, usually equal on both sides, that spares the feet. Pilates can be part of the exercise that helps; our exercise for lipoedema guide covers it.
Arm exercises usually start soon after surgery, "ideally the day after your surgery", Breast Cancer Now says, and NICE asks breast units to teach them. Start Pilates once that early programme is done and your wounds have healed, as our Pilates for cancer guide says, which also covers the shoulder and arm after breast cancer.
"It's usually possible to carry on doing any exercise or sporting activities you did before your surgery", Breast Cancer Now says; take up anything new gradually, and stop if you notice swelling.
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Slow breathing, 5 breaths at the start and end (our lymphoedema exercises routine); lateral breathing, 5 to 8 breaths at the start of every session; breath reach, 5 breaths, exhale longer than inhale (the moves' pages).
Shoulder rolls, 5 to 10 each way (our lymphoedema exercises routine). Band row, wall push-up and band shoulder press: 1 set of 8 to 10 at the lightest band to start, adding a little only after a week or two with no change (our suggestion, from the PAL protocol). Mermaid, 3 each direction, each side; swimming with your arms by your sides at first, 2 to 3 sets of 20 to 30 seconds (the moves' pages).
Ankle circles, 10 pumps then 5 circles each way (our lymphoedema exercises routine). Knee fold, 2 sets of 5 to 10 each side, every other day; heel slide, 10 slow repetitions each side, once or twice a day; single-leg circle, 5 circles each direction, each leg; wall bridge, 8 to 10 reps (the moves' pages). Calf raises, 10 to 15, and sit-to-stands, 2 sets of 8 (our editorial starting point).
3D demoAnkle circlesBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoWall bridge (feet-on-wall bridge)Beginner · A wall
3D demoSlow calf raiseBeginner · A wall
3D demoSit to stand from a chairBeginner · A bench or boxSide kick, 8 to 10 each side (the move's page). Bridges, 2 sets of 8; clamshells, 10 each side; bird dog, 6 each side, without long holds (our editorial starting point).
Swap the knee hover, planks, the side plank and long wall sits for moving exercises. Macmillan says to "Avoid exercises where you use your muscles without moving your body", such as the plank, and our Pilates for cancer guide says: "With lymphoedema, swap planks and the knee hover for moving exercises."
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Bring back the leg pull front and Pilates push-ups last, built up like any other arm load (our suggestion, from the PAL protocol).
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Reformer foot straps, a band looped round the wrist or ankle, or a tight ring squeeze: avoid anything that digs into the swollen limb or leaves a mark (our suggestion; skin care is one of the four parts of treatment).
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The NHS says the heat from saunas, steam rooms and sun beds may increase the swelling, and Breast Cancer Now says swelling can be worse in hot weather. Skip hot Pilates (our suggestion).
Macmillan says you should not exercise if you have a skin infection (cellulitis), and the NHS says not to wear compression stockings until you're better. Our exercise for lymphoedema guide covers what to do.
Do the daily lymphoedema routine every day, our 25-minute Pilates class 2 or 3 times a week, and walking, cycling or swimming on most days. In the first months after breast surgery, use your team's arm exercises first.
A 25-minute Pilates class for lymphoedema: breathing first, shoulder and leg pumping moves, side-lying work and light strength built up slowly, with no long holds.
25 minBeginner17 movesA wall, A bandA 15-minute daily routine for lymphoedema: deep breathing, neck and shoulders, then an arm block and a leg block to keep the muscle pump working.
15 minBeginner14 movesOther / check instructions, A bench or boxA gentle 25-minute Pilates class for during and after cancer treatment: breathing, shoulders, legs and balance, with no curls, twists, planks or rolling.
25 minBeginner17 movesA bench or box, A bandThe UK breast surgery leaflet's exercises in one daily routine: a shoulder warm-up, the basic set for week 1 and the stretching set from week 2.
15 minBeginner6 movesA wall, Other / check instructionsA full-body resistance band workout: squats, rows, push-ups, presses, pull-aparts, band walks, good mornings and flyes.
30 minBeginner9 movesA band, An anchor pointA 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 weekly structure for strength and walking. Start the upper body lighter than the plan says, and keep the daily routine going alongside it.
Your first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginner6 days a weekA free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginnerThese are the same warning signs as our exercise for lymphoedema and Pilates for cancer guides, 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.
If you have cellulitis with any of these, which can be signs of sepsis:
Call 999 or go to A&E if breathing suddenly becomes difficult, if pain in your chest or upper back comes on suddenly with breathlessness or a very fast heartbeat, or if someone passes out.
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Same day (urgent GP appointment or NHS 111): throbbing pain in one leg (rarely both), usually the calf or thigh; swelling in one leg (rarely both); red, blue or darkened skin around the painful area, which may be harder to see on brown or black skin; or swollen veins. This can be a deep vein thrombosis (DVT). It is more likely after surgery, a hospital stay, 3 or more days in bed, a journey of over 4 hours, pregnancy or a recent birth, cancer, a previous clot, or contraception or hormone replacement therapy (HRT) that contains oestrogen.
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Rest and raise the limb. If your compression garment hurts, take it off, and put it back on as soon as you can tolerate it. Go back to your normal activity once you feel better, and have your garment's fit checked, as the limb may be more swollen afterwards. If you've been given a "rescue pack" of antibiotics after a previous attack, start it at the first familiar symptoms and get medical advice as soon as you can.
New swelling with no signs of a clot or infection: see your GP or cancer team, who may refer you to a lymphoedema service.
Signs of infection (cellulitis) or a blood clot in a swollen limb need urgent medical attention. If the swollen or at-risk area changes during or after exercise, stop and contact your lymphoedema specialist.
Call 999 if:
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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.
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.
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.
In the PAL trials, slowly built-up weight lifting didn't raise the risk in women at risk (11% against 17%) or increase swelling in women with lymphoedema (11% against 12%), and flare-ups were less common. NICE says there's no indication that activity causes or worsens lymphoedema.
Arm exercises usually start the day after surgery, and in UK PROSPER, structured exercise from 7 to 10 days, with bands from a month, improved arm function with no increase in lymphoedema. Follow your team's timing.
Muscle movement is what pumps lymph, and a lack of limb movement can cause lymphoedema. The exception is cellulitis: don't exercise until you're better.
Exercise barely shrinks established swelling, the Pilates evidence for swelling is very uncertain, and compression is the first treatment.
No study has measured toxins or drainage during a Pilates routine. Movement does help lymph move, as walking does.
Sessions without a garment didn't worsen swelling in small trials, and international guidance calls it an individual decision, while UK charities prefer you wear one. Follow your team's advice.
Yes. NICE says there's no evidence that physical activity, including arm exercise, will make lymphoedema worse, and the British Lymphology Society lists Pilates among suitable activities wherever the swelling is. Start slowly, wear your garment if you've been given one, and tell your teacher.
The small trials disagree. Some found less swelling with Pilates, but they compared supervised classes with home exercise alone, and others found no change in arm volume; a 2026 overview calls the evidence very uncertain. Expect better strength, movement and comfort, and rely on compression for the swelling.
Yes, once your team's early arm exercises are done and your wounds have healed. Being active doesn't raise the risk, and in the PAL trial slowly built-up weight lifting didn't bring on lymphoedema in women at risk. Our Pilates for cancer guide covers the shoulder and arm after surgery.
If you've been given one, yes, unless your team says otherwise: the British Lymphology Society says it's generally best. Small trials found exercising without one didn't worsen swelling, so it's partly personal preference. You don't need it in the pool.
One small trial of 20 women found 10 weeks of equipment Pilates, including the reformer, improved movement, swelling, pain and quality of life more than home exercise. Build up the springs slowly like any arm load, and avoid straps that dig into the swollen limb.
Moving exercises that pump the muscles: breathing first, then shoulder and arm movements, knee folds, leg circles, bridges, side kicks and band work, built up slowly. Our 25-minute class has arm and leg options, and the daily lymphoedema routine adds the hand and foot pumps.
Swap long holds such as the plank and side plank for moving exercises, as Macmillan advises. Bring back weight on your hands last, and avoid anything tight around the swollen limb. Don't exercise at all while you have cellulitis.
A little extra swelling straight after exercise is common and should settle; in a small trial it was back to normal within 24 hours. If it doesn't settle, or the limb aches, feels hotter or takes longer to recover than usual, do less next time and ask your lymphoedema team. "Skin that is painful, hot and swollen can be cellulitis: ask for an urgent GP appointment or get help from NHS 111."
Probably, as exercise, but it hasn't been tested: there's no Pilates trial in leg lymphoedema. Exercise studies in legs are few and small, and cellulitis was the main complication, so build up slowly and look after your skin and feet.
Any movement helps lymph move, because muscles squeeze the lymph vessels and breathing changes the pressure in your chest. But no study shows a Pilates routine drains lymph better than walking, and none has measured toxins. See a GP about "Swollen legs, ankles or feet that haven't improved after a few days".
It can be part of the exercise that helps, but lipoedema is a different condition from lymphoedema: a build-up of fat, usually equal on both sides, that spares the feet. Our exercise for lipoedema guide covers it.
We'd skip it: the NHS says heat from saunas, steam rooms and sun beds may increase the swelling, and Breast Cancer Now says swelling can be worse in hot weather. No study has tested hot Pilates.
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.
