Pilates guide
Pilates suits men in their 40s and 50s: it trains the muscles around your trunk and back, loosens stiff hips and hamstrings, and the NHS counts it as strength activity when you work until you need a short rest. For long-lasting back pain it is one of the best-supported types of exercise. But it is light exercise and no better than other training for strength, so it sits alongside lifting and the 150 minutes of brisk activity a week, not in place of them.
This guide covers what changes from 40, what the trials in men show (very few, and small), back pain, stiffness, strength and recovery, the heart, the pelvic floor, mat or reformer, the moves and classes to start with, and a week that fits around the gym or sport. Our Pilates for men and Pilates for older men guides cover men of any age and men over 60. Chest pain or tightness when you're active means stop and get help: the warning signs are below.
The NHS counts Pilates as muscle-strengthening activity if you work until you need a short rest. But it's light exercise: a traditional mat class uses about 1.8 METs (multiples of the energy you use at rest), against 3 or more for moderate activity, so it doesn't count toward the 150 minutes of moderate activity a week.
One small trial, of 36 men aged 40 to 55 with long-lasting low back pain, found Pilates eased pain as much as McKenzie exercise. Most Pilates trials recruit women, so this guide leans on trials of men and women together and on strength research that included men.
Against minimal treatment, Pilates eased long-lasting low back pain by about 14 points out of 100 in the short term, from low-quality evidence. Against other exercise, no type is clearly better.
Heavier loads, 2 to 3 sets and at least 2 sessions a week build strength. In older adults, Pilates was no better than other exercise for strength. The UK guidelines now say strength work matters as much as the 150 minutes.
Hamstring flexibility improved in small trials over 8 to 12 weeks, and every move has an easier version.
Add 150 minutes of moderate or 75 of vigorous activity a week, such as brisk walking, cycling or sport. Chest pain or tightness when you're active means stop and get help (below).
In 120 adults first tested at 46 to 78 and again about 10 years later, knee strength fell about 14% a decade, and men's elbow strength fell 12% a decade against 2% in women. On MRI (magnetic resonance imaging) scans, muscle mass fell noticeably only from about 50, mostly in the legs (figures from the abstract; a later correction to the paper couldn't be read). In studies that measured both, strength was lost 2 to 5 times faster than muscle.
Across 49,964 people in 12 British studies, men's grip peaked at about 51 kg between 29 and 39 and declined from midlife. In 6,089 men aged 45 to 68 followed for 25 years, the weakest third of grips had nearly 3 times the odds of walking slowly in old age: an association, not proof.
The NHS calls the "male menopause" "an unhelpful term sometimes used in the media". Testosterone falls steadily, about 1% a year from around 30 to 40, and "this is unlikely to cause any problems in itself". Low mood, poor sleep, low energy and erection problems have many causes; if you have them, the NHS suggests seeing your GP.
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In the Cochrane review of 249 exercise trials for long-lasting back pain, volunteers averaged 43, so the back pain research sits squarely in your age group. Our Pilates for back pain guide has the detail.
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Mostly lying, kneeling and seated work for the trunk, hips and spine, done slowly with the breath; the reformer adds springs. The 2024 Compendium of Physical Activities lists a traditional mat class at 1.8 METs and Pilates in general at 2.8, where moderate activity starts at 3. So a class trains control, endurance and mobility, and does little for your heart and lungs.
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In adults over 55, 31 of 51 Pilates trials recruited only women and 1 only men. Our searches found one Pilates trial in men aged 40 to 55 alone: 36 men with back pain, in a small palliative care journal. So most of this guide comes from trials of men and women together, and from strength and activity research that included men.
The free NHS Health Check is for people aged 40 to 74 without an existing condition such as heart disease, diabetes or high blood pressure. You don't usually need a medical check before starting light or moderate activity, such as brisk walking, if you're well, the World Health Organization's guidelines say.
36 men with low back pain for more than 3 months did Pilates (an hour, 3 times a week for 6 weeks), McKenzie exercise or no treatment, 12 men in each group. Pilates and McKenzie eased pain about equally, and Pilates improved general health scores more. Small groups, short follow-up and a palliative care journal outside the field: a start, not proof.
In 50 people, 12 weeks of a basic mat routine twice a week improved abdominal endurance, hamstring flexibility and upper-body endurance, but not posture or balance.
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In 40 adults averaging 32, 8 weeks of Pilates twice a week improved sit-and-reach, and 85% passed a test of control around the lower back and pelvis, against none of the comparison group.
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In exercise trials for back pain, side effects were minor, mostly soreness and temporary pain, and no serious adverse events were reported.
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In the Cochrane review (10 trials, 510 people), pain fell about 14 points on a 0 to 100 scale in the short term against minimal treatment, from low-quality evidence. Its search ended in 2014; newer reviews agree on the direction.
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Across 118 trials of 9,710 adults aged 18 to 65, Pilates ranked highest for easing pain and disability; in 89 studies it ranked first for pain; and in 82 trials it was the most effective type at the doses studied. Certainty was mostly low or very low. The 89-study review drew an expression of concern after critics wrote to the journal, which the editors later rescinded.
Head to head (11 trials), no exercise type was clearly better for long-lasting back pain, though Pilates beat general exercise for pain with low certainty. An umbrella review of 70 reviews found small, mostly short-term benefits from Pilates, motor control, mixed exercise, tai chi, water exercise and yoga against minimal treatment.
The trials ran 1 to 3 sessions a week for 3 to 12 weeks, and the best programmes included at least 1 to 2 sessions a week of Pilates or strength exercises. Twice a week for 8 to 12 weeks is our editorial starting point.
Across 21 trials of 30,850 people, exercise combined with education cut the risk of a new episode of back pain (moderate-quality evidence); back belts and insoles didn't help. In 701 adults, a walking and education programme delayed the next bout (a median of 208 days against 112). No trial has tested Pilates for preventing back pain.
The American College of Sports Medicine's 2026 position stand (137 reviews, more than 30,000 people): strength grew most with heavier loads (80% or more of the most you can lift once), 2 to 3 sets and at least 2 sessions a week; muscle grew most with 10 or more sets a week. Its advice applies across all ages.
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In older adults, Pilates made no difference to strength against other exercise (24 trials), and the reviewers didn't recommend it for strength, endurance or power. No trial has compared Pilates with weights in middle-aged men.
The 2026 update to the UK guidelines says strength work should be "considered as important as achieving 150 minutes" of moderate or vigorous activity a week, and is "particularly important for adults at the upper end of the 19 to 64 age range". The NHS counts Pilates as strengthening when you work until you need a short rest.
Across 16 cohort studies, muscle-strengthening activity went with a 10% to 17% lower risk of death, heart disease, cancer and diabetes, with the largest drop at about 30 to 60 minutes a week. In 147,374 US health professionals, 90 to 119 minutes a week of resistance training went with 13% lower death rates, with no extra benefit above 120 minutes, and the lowest risks came with aerobic and resistance training together. Cohorts can't prove cause.
Strength training on 2 or 3 days and Pilates on 1 or 2 is our editorial starting point. Our Pilates strength workout puts load and Pilates in one class, and our workout plan for men over 40 is the strength week to build around.
Hamstring flexibility improved over 12 weeks in active middle-aged adults, and sit-and-reach over 8 weeks in younger adults. Start with bent knees and a smaller range, and expect it to take weeks, not days.
In 3,139 adults aged 46 to 65 at a Brazilian exercise clinic (66% men), a 20-movement flexibility score was 35% higher in women than in men, and the least flexible men had 1.87 times the risk of dying over about 13 years. People who needed more support to sit down on the floor and get up again also had higher death rates. Both are associations from one clinic: they don't show that stretching or Pilates adds years.
A mat class is light activity, so it doesn't count toward the 150 minutes of moderate activity, or 75 of vigorous, a week. Walking, cycling, running or sport do.
In 31 trials of 1,345 people with high blood pressure, Pilates lowered the lower (diastolic) number over 24 hours by about 4 mmHg (millimetres of mercury), but the authors call the Pilates data "limited and imprecise". Our Pilates for high blood pressure guide has more.
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Our searches found no study of Pilates as recovery from lifting or sport, or for muscle soreness, and none of Pilates and testosterone. Gentle mobility on a rest day is reasonable (our suggestion).
Prostate Cancer UK teaches pelvic floor squeezes for leaking, and a strong squeeze after you pee to stop dribbling. After prostate surgery, NICE (the National Institute for Health and Care Excellence) recommends supervised pelvic floor training for at least 3 months for leaking. An enlarged prostate "is most common in men over 50 years old", the NHS says. Our Pilates for the prostate and older men guides have more.
The hundred: 50 beats to start, building to 100, with your head down if your neck aches, and swimming: 2 to 3 sets of 20 to 30 seconds (from the move pages' doses); dead bug: 2 sets of 8 each side, bird dog: 2 sets of 6 each side with a 5 s hold, side plank: 2 holds of 20 to 30 s each side, knees down to start, and half-kneeling Pallof press: 2 sets of 8 each side (our Pilates for weightlifters class); leg pull front: 3 to 5 each side, and roll-up: 3 to 5 slow reps, knees bent if your feet fly up (from the move pages' doses).
3D demoHundred (Pilates)Intermediate · No equipment
3D demoDead bugBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoSide plankIntermediate · No equipment
3D demoHalf-kneeling Pallof pressBeginner · A band + An anchor point
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoLeg pull front (Pilates leg pull down)Advanced · No equipment
3D demoRoll-up (Pilates)Intermediate · No equipmentSpine stretch forward: 3 to 5 reps, saw: 3 to 4 each side, and single-leg circle: 5 circles each direction, each leg (from the move pages' doses); 90/90 switch: 10 slow switches, pause at the ends, thoracic rotation: 6 rotations per side, moving with the breath, and cat-cow: 8 waves, slower than feels natural (the move pages' doses); hamstring stretch with a strap: 30 s each side, easing off if you feel tingling down the leg (our Pilates for weightlifters class); open book: 8 slow openings each side (our Pilates for mobility class).
3D demoSpine stretch forward (Pilates spine stretch)Beginner · No equipment
3D demoSaw (Pilates)Intermediate · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demo90/90 switchIntermediate · No equipment
3D demoSupine hamstring stretch with a strapBeginner · No equipment
3D demoSide-lying open bookBeginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoCat-cowBeginner · No equipmentGoblet squat: 3 sets of 8 to 12, reverse lunge: 2 sets of 8 to 10 each side, and push-up: 3 sets, stopping 2 to 3 reps short of failure, knees down if you need to (our Pilates strength workout); hip hinge practice: 8 (our Pilates for weightlifters class), then dumbbell Romanian deadlift: 3 sets of 8 to 12 (our Pilates for women over 40 class); band row: 3 sets of 10 to 15, stopping 2 to 3 reps short of failure (from the move page's dose); farmer's carry: 2 walks of 30 m (our Pilates for longevity class); single-leg stand: 2 holds of 30 s each leg, eyes closed once it's easy (our Pilates for weightlifters class). Add weight as sets get easier.
3D demoDumbbell goblet squatIntermediate · A dumbbell
3D demoReverse lungeIntermediate · No equipment
3D demoHip-hinge practiceBeginner · No equipment
3D demoDumbbell Romanian deadliftIntermediate · A dumbbell
3D demoBand rowBeginner · A band + An anchor point
3D demoPush-upIntermediate · No equipment
3D demoFarmer's carryIntermediate · A dumbbell + A kettlebell
3D demoSingle-leg standBeginner · A wall8 slow squeezes held up to 10 s, then 8 quick squeezes, squeezing from the front as if stopping your pee and from the back as if stopping wind, then 5 slow breaths to let go (our Pilates for men's pelvic floor class).
Our editorial week, built on the UK guidelines, the NHS activity guidelines and the American College of Sports Medicine's position stand; our workout plan for men over 40 sets out the strength week.
Our Pilates strength workout is the main class: goblet squats, reverse lunges, single-leg bridges, band rows, push-ups and shoulder presses, then harder Pilates trunk moves. The mobility class is for stiff hips and upper backs, the weightlifters' class is rest-day Pilates for lifters, and the back pain, hamstrings, men's pelvic floor, beginner and longevity classes each cover one need.
A 30-minute Pilates strength class with dumbbells or a band: Pilates trunk work plus squats, lunges, rows and push-ups, each set taken until it is hard.
30 minIntermediate15 movesDumbbell, bandA 25-minute Pilates mobility class: standing joint circles, spine and hip work on the mat, strength at the end of your range, then sit-to-stands and balance.
25 minBeginner18 movesWall, bench or boxA 25-minute rest-day Pilates class for lifters: trunk endurance, the hinge, ankles and hips, the upper back and overhead position, breathing on every effort.
25 minIntermediate18 movesWall, bandA gentle 15-minute Pilates-based routine for ongoing low back pain, built from neutral-spine moves with options for backs that dislike bending or arching.
15 minBeginner10 movesNo equipmentA 25-minute Pilates class for tight hamstrings: a warm-up, bridges and kicks that make them work, Pilates' moving stretches, then a few held stretches.
25 minBeginner17 movesDumbbell, other / check instructionsA 20-minute men's pelvic floor Pilates class: find the squeeze and the release, then use it lying, seated and standing, for leaks after prostate surgery and erections.
20 minBeginner14 movesBench or box, something with weightA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentA 35-minute Pilates class for ageing well: a brisk start, leg and grip strength, balance at a counter, getting down to the floor and up, and mat work.
35 minBeginner19 movesBench or box, stepThe men over 40 plan has three strength days, two cardio days and a mobility day; a Pilates class can take the mobility day (our suggestion). The men over 50 plan is for your 50s.
A 3-day strength plan for men over 40 with power and bone work, two cardio days and mobility, built on research on ageing muscle.
3 training days45 minBeginner3 days a weekA 12-week workout plan for men over 50: three strength days with power and balance work, cardio and recovery, at the gym or at home, with a 4-day option.
3 training days45 minBeginnerThe NHS says to stop back exercises if your pain gets worse, and to see a GP for advice. As a rule of thumb from our back pain guides, mild pain up to about 5 out of 10 that settles within an hour and is no worse the next morning is fine. Leg symptoms are the exception: stop any move that sends pain, tingling or numbness further down a leg.
Some discomfort during exercise is fine, and it does not mean you are doing damage: the WHO counts "hurt does not necessarily mean harm" among the messages people with back pain need. Aim for pain you would call mild to moderate, no more than about 5 out of 10. It should settle within an hour or so, and your back should be no worse the next morning. If it is worse, do less next time (fewer reps, a smaller range, a lighter load), not nothing.
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Use the half roll back instead of the roll-up, or skip it, during a disc-related flare, as the roll-up's move page says.
Stop if you feel a sudden sharp pain, a snap or a pop at the back of the thigh during a stretch: it may be a hamstring strain. Our hamstring strain guide says when to get help.
Prostate Cancer UK says not to do pelvic floor exercises while you have a catheter in, and to start them as soon as it has been removed. Ask your surgical team before other floor exercises or lifting (our suggestion), and see our Pilates for the prostate guide.
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Breathe out as you lift, and don't hold your breath.
If you have a heart condition, follow your cardiac team's advice on how hard to work, and stop for the warning signs above. People with long-term conditions may wish to ask their specialist before starting. With uncontrolled high blood pressure, avoid straining against a held breath; the high blood pressure guide has more.
On a rest day or after lifting, once or twice a week; not in the hour before heavy sets (our suggestion).
Start where you're comfortable: chair, wall and standing versions all count. Our Pilates for plus-size bodies guide covers getting up and down from the floor and the equipment that helps.
These are the warning signs of our older men, spine and Pilates guides, word for word; the health check and prostate surgery lines are ours. 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:
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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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.
Get help from NHS 111: you're suddenly more short of breath than usual; you have chest pain and you feel sick or are being sick; or you have chest pain and you feel like your heart is racing, going too slowly, skipping a beat or fluttering.
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If you have back pain and any of these. The first four can be signs of cauda equina syndrome, pressure on the nerves at the base of the spine, which needs treating in hospital urgently. Don't drive yourself: ask someone to drive you or call an ambulance.
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Call 999: sudden, severe pain in the tummy or back, which can come with breathlessness, pale or grey skin, or collapse. It can be a burst abdominal aortic aneurysm, most common in men aged 65 or over and in people who smoke or used to smoke.
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If you have back pain and you feel hot, cold, shivery or generally unwell, or the pain is severe and started suddenly, or is getting worse quickly. In the US, contact your doctor or urgent care.
Same day: you have or have had cancer, and new back pain that is severe and doesn't let up, is getting steadily worse, is worse at night and disturbs your sleep, is worse when you cough, sneeze or strain, or comes with tenderness over the spine. Contact your cancer team or GP urgently. With cancer, new weakness, difficulty walking, numbness or bladder or bowel problems are an emergency.
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If you have back pain and:
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The NHS lists:
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You have difficulty peeing or need to pee more often. The NHS says: "Try not to be embarrassed. The GP will be used to talking about these symptoms." It's important to get these symptoms checked, because they can sometimes be caused by something more serious, such as prostate cancer. Our Pilates for the prostate guide lists the signs that need 999.
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The NHS says erection problems that keep happening "might be a sign of a health condition that can be treated", such as high blood pressure, high cholesterol or diabetes, so see a GP or a sexual health clinic too.
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For a bulge in your groin or tummy that is painful, or comes with a swollen tummy, being sick or constipation, as our guide to exercise for men explains. In the US, contact your doctor or urgent care.
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 Health Check is a free check-up of the health of your heart and blood vessels for people aged 40 to 74 who don't already have a condition such as heart disease, diabetes, high blood pressure or kidney disease; your GP or local council should invite you every 5 years. You don't need one before starting Pilates, but it's a good prompt at this age (our suggestion).
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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.
If you have a heart, lung or joint condition, are pregnant or have recently been unwell, start gently and read our guide for your condition. Muscle soreness for a day or two after a new exercise is common and fades as you repeat it.
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Most trial volunteers are women, but that reflects who signs up, not who benefits. The back pain trials included men, and in the one trial of men aged 40 to 55, pain eased as much as with McKenzie exercise. Our Pilates for men guide covers the method's history.
Flexibility is one of the things Pilates improves in small trials, and every move has a bent-knee or smaller version.
It's light activity and no better than other exercise for strength. You still need strength work on at least 2 days and 150 minutes of moderate activity a week.
Pilates eases long-lasting back pain in the short term, but no trial has tested it for preventing back pain. Exercise with education, and walking, are what prevention trials support.
It ranks at or near the top in network comparisons, with low certainty, but head-to-head reviews find no type clearly better. The best exercise is one you'll keep doing.
No study has tested it. Gentle mobility on a rest day is reasonable (our suggestion).
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No study has found that. The NHS calls the "male menopause" an unhelpful term and says the slow fall in testosterone is unlikely to cause problems by itself.
Light Pilates builds little muscle and won't strip it either; muscle follows load and the number of hard sets you do.
Low flexibility went with higher death rates in one clinic's patients, an association; the authors call for studies of whether getting more flexible helps.
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The trials in men and middle-aged adults were mostly mat classes, and no trial has compared mat and reformer in men.
Yes, as one part of the week. It trains your trunk, back and mobility, and the NHS counts it as strengthening if you work until you need a short rest. Keep strength training and aerobic activity alongside it.
It can be: in the one trial of men aged 40 to 55 with long-lasting back pain, Pilates eased pain as much as McKenzie exercise. That trial was small, and most Pilates research is in women, so the strongest evidence comes from trials of back pain in men and women together.
Yes. Start with a beginner class twice a week, using the easier versions, and add a little every week or two. You don't usually need to see a GP first for light or moderate activity, unless you have symptoms or a health condition (see the warning signs).
It's one of the best-supported exercises for long-lasting back pain, in trials of men and women: it eased pain by about 14 points out of 100 in the short term against minimal treatment. It isn't proven better than other exercise you'll keep doing, and walking helps too.
Not much on its own. Muscle and strength grow with heavier loads you keep adding to, on at least 2 days a week; in older adults, Pilates was no better than other exercise for strength. Add weights or bands, and use Pilates for control and mobility.
Both, for different jobs. The UK guidelines now say strength work should be considered as important as the 150 minutes of activity, especially toward the top of the 19 to 64 age range. Pilates adds trunk endurance and mobility.
No. A mat class is light activity, so you still need 150 minutes of moderate activity, such as brisk walking or cycling, or 75 minutes of vigorous activity a week.
Probably: hamstring flexibility and sit-and-reach improved in small trials over 8 to 12 weeks. Start with bent knees and a smaller range, and expect it to take weeks, not days.
No study has tested it. Gentle mobility on a rest day is reasonable, but leave Pilates ab work out of the hour before heavy lifting (our suggestion).
No study shows Pilates changes testosterone. The NHS says testosterone falls slowly, about 1% a year from your 30s, and that this is unlikely to cause problems by itself; low mood, poor sleep or erection problems are worth a GP visit.
Either. The back pain and flexibility trials were mostly mat classes; the reformer's springs add load and help you learn some moves, but no trial has compared them in men.
Call 999 for chest pain or tightness that doesn't go away, or chest pain spreading to your arm, neck or jaw. Back pain with numbness around your genitals or bottom, new bladder or bowel problems, or weakness in both legs also needs 999 or A&E. See a GP for difficulty peeing, or erection problems that keep happening.
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.
