Exercise is safe with MS
NICE says regular exercise "does not have any harmful effects" on MS, and in 40 trials, exercise didn't raise the risk of a relapse.
Pilates guide
Pilates for MS (multiple sclerosis): balance, fatigue, heat and how to adapt
Exercise is safe and recommended with multiple sclerosis (MS), and the National Institute for Health and Care Excellence (NICE) names Pilates, alongside yoga and aerobic, strength and balance exercise, as something that may help MS fatigue. In more than 20 small trials, Pilates improved balance and everyday mobility compared with usual care or no extra exercise, at low certainty.
It hasn't been shown to beat other exercise: in the largest UK trial, Pilates did no better than relaxation for walking speed. So choose it because you enjoy it and can keep it up, alongside walking or cycling and strength work.
This guide covers what the trials found for balance, walking, falls, fatigue and mood, how to adapt Pilates for heat, fatigue and balance, how to tell a relapse from a heat flare, and a free 25-minute workout with seated, standing and mat parts that builds up slowly.
The short version
NICE names Pilates for fatigue
NICE says aerobic, strength and balance exercise, "including yoga and pilates, may be helpful in treating MS-related fatigue". The MS Society says Pilates "helps most when you practice often and over a longer period of time".
Balance improves, at low certainty
In a 2026 analysis of 22 small trials (901 people), Pilates improved the Timed Up and Go test by about 5 seconds and a balance score by about 8.6 points compared with control groups, at low certainty. No result in the analysis reached high certainty.
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But not more than other exercise
In the largest UK trial, of 100 people, Pilates did no better than relaxation for walking speed. It matched physiotherapy in another trial, and a review found it no more effective than other therapies.
Start easy and build up slowly
A home Pilates trial started with 4 repetitions of each move and added 2 every fortnight, up to 10, twice a week. International recommendations say supervised training generally works better than training on your own.
Keep cool and pace yourself
Heat can bring on symptoms for a few hours, "not usually due to new MS damage". Keep the room cool, take breaks, and stop before you're exhausted.
MS, fatigue and heat in brief
MS
"Multiple sclerosis (MS) is a condition that affects the brain and spinal cord", the NHS says. Common symptoms include extreme tiredness (fatigue), vision problems, numbness or tingling, "feeling off balance, dizzy or clumsy", muscle stiffness and spasms, bladder problems and problems with memory or concentration. In relapsing remitting MS, symptoms flare up and then ease; in progressive MS, they slowly get worse.
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Who the trials included
Trials describe people by a disability score from 0 to 10 (the Expanded Disability Status Scale). The Pilates trials mostly included people who could walk, with or without an aid, at scores up to 6.5: from few symptoms to walking short distances with a stick or walker.
Fatigue
NICE says MS fatigue "may be brought on by heat or biological, physical and emotional stress". The MS Trust says "it is not a good idea to 'work through' fatigue": you may end up feeling worse, often for days afterwards.
Heat sensitivity
About 6 in 10 people with MS report symptoms that get worse when their body temperature rises, from hot weather, hot baths, saunas, exercise or a fever. The symptoms "should improve within a few hours once you cool down", and the increase "is not usually due to new MS damage", the MS Trust says.
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Pilates for MS in practice
Trials used physiotherapist-led Pilates, Pilates-based core training, mat and reformer classes, home programmes on DVD and live video classes. The MS Society has free Pilates videos for "all levels of mobility": a floor-to-standing session, a seated one and a seated-and-standing one. The MS Trust says "An experienced yoga or Pilates class leader should be able to adjust the class to take your physical needs into account".
What NICE and the MS charities say
NICEStrong evidence
"Encourage people with MS to exercise. Advise them that regular exercise may have beneficial effects on their MS and does not have any harmful effects on their MS." For fatigue, NICE says aerobic, strength and balance exercises, including yoga and Pilates, may help. For mobility problems or fatigue, it suggests supervised programmes of moderate progressive strength training and aerobic exercise, choosing the option you prefer and can keep doing, and help to keep exercising, such as referral to a physiotherapist with MS expertise or an exercise referral scheme.
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The MS Society
"Research tells us practicing Pilates can help you to manage your MS. It helps most when you practice often and over a longer period of time. Even doing little or few exercises regularly can make you feel better." The society lists symptoms Pilates can help with, including balance and fatigue. For exercise in general, it suggests starting slowly, warming up and cooling down, and asking about your local exercise referral scheme.
The MS Trust
"The attitude of 'no pain, no gain' does not apply in MS": stop before your body tells you you've reached your limit. If fatigue is a problem, the trust suggests focusing on strengthening exercise. It also suggests standing for some exercises when you can, to keep the muscles you use for standing strong.
International recommendationsStrong evidence
Recommendations from an international expert panel encourage at least 150 minutes a week of exercise or everyday activity. For people with mild disability, they suggest aerobic exercise 2 to 3 times a week, strength exercise 2 to 3 times a week (1 to 3 sets of 8 to 15 repetitions), daily stretching, and balance and coordination work 3 to 6 times a week for 20 to 60 minutes, which might include Pilates, yoga, dance or tai chi. The same applies, with adaptations, to people who walk with an aid.
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What the evidence says
Balance and everyday mobility improveEmerging evidence
In a 2026 network meta-analysis of 22 trials (901 people in Turkey, Iran, Ireland, Canada, the UK and Israel), Pilates improved the Timed Up and Go test (standing up from a chair, walking 3 metres, turning, walking back and sitting down) by about 5 seconds, and the Berg balance score by about 8.6 points out of 56, compared with control groups, at low certainty. No result in the analysis reached high certainty, most comparisons were only against control groups, and 10 of the 22 trials were at high risk of bias. The authors say routine use "should await adequately powered trials".
Earlier reviews of 8 and 20 trials also found better balance, and a 2026 overview found mind-body exercise improved balance, at low to very low certainty.
Walking: mixed resultsMixed evidence
In the 2026 analysis, Pilates added about 5 metres to a 6-minute walk, and no Pilates programme improved the 10-metre walk. In 30 people, twice-weekly group Pilates plus massage added about 52 metres to the 6-minute walk, against 15 metres with massage alone.
In the largest UK trial, of 100 people with moderate MS, 12 weeks of Pilates did no better than relaxation for walking speed; a set of standard exercises did a little better than relaxation. In 42 people, weekly Pilates plus home exercise didn't improve walking speed more than home exercise, though it did improve walking endurance and balance.
Falls: not testedMixed evidence
None of the Pilates trials we reviewed counted falls. In a Cochrane review of 13 trials of falls prevention in MS, exercise may reduce the rate of falls, but the evidence was very low certainty. Pilates improves balance tests; it hasn't been shown to prevent falls.
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Pilates against other exerciseMixed evidence
Pilates was no better than relaxation for walking speed in the largest trial, and no better than standard physiotherapy for walking and balance in 45 people. A 2019 review found it "not more effective than other therapies" for mobility, fitness, fatigue or quality of life. In a network analysis of 7 kinds of exercise, yoga ranked best for balance and water exercise for the Timed Up and Go; Pilates didn't rank first for either.
In 28 people in a study that wasn't randomised, Pilates improved walking speed more than yoga, and online Pilates and online yoga gave similar gains in two trials.
Mat or reformerEmerging evidence
In 38 people, mat and reformer Pilates twice a week gave similar gains, with a little more trunk strength from the reformer.
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Seated and wheelchair PilatesEmerging evidence
In 15 wheelchair users with MS, 12 weeks of Pilates improved sitting balance, posture and shoulder and back pain, though there was no comparison group. In a pilot of 22 people with mild to severe MS (16 finished), online seated Pilates twice a week for 12 weeks improved a balance score by about 10%.
Safety: exercise doesn't raise the risk of relapseStrong evidence
Across 40 trials, exercise didn't raise the risk of relapse or of serious side effects. Pilates trials reported few side effects and good attendance, though a 2026 review notes that safety wasn't always reported. In the UK Pilates trial, 6 of 100 people had a relapse during the study and dropped out; the summary doesn't say which groups they were in.
Fatigue, mood and quality of life
Exercise eases MS fatigueStrong evidence
In a Cochrane review of 45 trials, exercise reduced fatigue compared with no exercise (moderate-quality evidence), and the authors say exercise "can be prescribed in people with MS without harm". NICE names yoga and Pilates among the exercise that may help.
Pilates and fatigue: mixedMixed evidence
In 80 people with mild MS who had never done Pilates, 8 weeks of home Pilates on DVD, twice a week, reduced fatigue against a waiting list, with no side effects or relapses. Pilates by video call 3 times a week reduced fatigue in 30 people. But results differ between fatigue questionnaires in the 2026 analysis, and reviews disagree: one found Pilates might help fatigue, another found no clear improvement.
Mood and quality of lifeEmerging evidence
The home Pilates trial also eased depression and anxiety. Online Pilates and online yoga 3 times a week for 8 weeks improved depression and quality of life in 45 women with relapsing MS, and in 82 people with relapsing or secondary progressive MS, with similar benefits in both types.
Thinking and back painEmerging evidence
In 46 people, 6 weeks of online Pilates improved thinking and doing two things at once. In 45 people, back pain eased about equally with individual Pilates, strength training or online Pilates.
How to do Pilates with MS
How often
Twice a week was the most common schedule in the trials, usually for 8 to 12 weeks. The international recommendations suggest balance and coordination work, which can include Pilates, 3 to 6 times a week, alongside aerobic and strength exercise.
Start easy and build up
In the home trial, people did 4 repetitions of each exercise for the first 2 weeks, then added 2 every 2 weeks, reaching 10 in the last 2 weeks, with sessions about 2 days apart. Participants described it as safe and at the right intensity, and said doing it at home removed some of the barriers to exercise.
Supervised first, then at homeEmerging evidence
In 50 people, supervised Pilates-based core training twice a week did better than the same programme at home for strength, balance and fatigue, though both improved, and the authors suggest home training for people who can't get to sessions. The international recommendations also say supervised training generally works better. Live video classes helped in small trials.
Keep cool
The MS Society and the MS Trust suggest:
- a cool, well-ventilated room, an open window or a fan
- breaking the session into shorter parts with regular breaks
- cold drinks, a cooling vest or a cool bath or shower before you start
- in a class, taking cold water and standing near a fan or open window, as classes "often take place in hot rooms"
- care with ice on the skin, because MS can change how you feel temperature
Pace yourself
Stop before you're exhausted. The MS Trust says that if you spend more time recovering from an activity than doing it, you may not have the balance quite right, so do a little less next time.
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Seated, standing or on the mat
Choose the level that suits you that day: the MS Society's free Pilates videos include seated, seated-and-standing and floor-to-standing sessions, and the MS Trust suggests standing for some exercises when you can. When balance is affected, the international recommendations suggest adapting the exercise or the environment. Our suggestion: do standing balance work next to a wall, worktop or sturdy chair.
Keep up your other exercise
Pilates adds balance and control. For fatigue and mobility, NICE names aerobic and progressive strength exercise as well, so keep walking or cycling and strength work in your week.
Seated
Start here, or stay seated for the whole session on a day when standing is hard. Start with about 4 repetitions of each move and build up slowly; the workout below gives doses.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoSeated marchBeginner · A bench or box
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box
3D demoThoracic rotationBeginner · No equipment
3D demoSeated overhead side bendBeginner · A bench or box
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weightStanding, next to support
Keep a hand on a wall, worktop or sturdy chair for every balance move. Our editorial starting point for the balance holds is 2 or 3 holds of 10 to 30 seconds.
On the mat
Only if you can get down to the floor and up again safely; practise that with someone nearby if your balance is poor. Start with 4 repetitions of each move and add 2 every fortnight, up to 10, as in the home Pilates trial.
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoDead bug heel tapsBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoSupine hamstring stretch with a strapBeginner · No equipment
3D demoGet up and down from the floorBeginner · No equipmentWorkouts to follow
The Pilates for MS workout has seated, standing and mat parts that you can mix to suit the day. The seated MS workout adds cardio and strength from a chair.
Pilates for MS: seated, standing and mat options
A 25-minute Pilates workout for multiple sclerosis (MS): seated, standing and mat parts, balance next to support, and gentle strength that builds slowly.
25 minBeginner14 movesA bench or box, A wall
Seated workout for MS: cardio, strength and stretches from a chair or wheelchair
A 25-minute workout done sitting, in a chair or wheelchair: seated cardio intervals, light strength work, posture and stretches, with pacing and cooling built in.
25 minBeginner14 movesA bench or box, A dumbbellChair Pilates workout
A 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 weight
Beginner Pilates for over-50s
A 20-minute beginner mat Pilates session for over-50s with no deep or repeated rounding of the spine, plus back strengthening and standing balance.
20 minBeginner13 movesA wall
Balance exercises routine
Balance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxStrength and balance exercises for seniors
A 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightA weekly plan
Once the MS workout feels easy, this plan gives three short sessions a week (two on the mat, one at a wall) with easy walks in between. On harder days, swap in the seated or standing parts of the MS workout.
Relapse or heat flare?
What a relapse is
A relapse is new symptoms, or old ones getting worse, that last more than 24 hours, after at least a month of stable symptoms, with no infection or other cause. Contact your MS team if you think you're having one.
Heat and other triggers
Heat, an infection such as a urine infection, stress or tiredness can make symptoms worse for a while (sometimes called a pseudo relapse). Symptoms brought on by heat should improve within a few hours once you cool down. If they don't settle, contact your MS team; your GP can check for an infection.
During a relapse
Our suggestion: rest from your Pilates programme, ask your MS team when to restart, then build up gently from a lower level.
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When to get help
Call 999 or go to A&E
The NHS says to call 999 (911 in the US) or go to A&E if you suddenly get any of these, as they could be signs of a stroke. Don't drive yourself.
- weakness or numbness in 1 arm
- loss or blurring of vision
- problems with balance and co-ordination
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Contact your MS team urgently
The MS Trust suggests getting advice more urgently for:
- a sudden loss of, or big change in, your vision
- weakness that's affecting how you get about
- problems with speech or swallowing
- sudden loss of bladder or bowel control
- feeling confused or drowsy
- symptoms that haven't improved, or are getting worse, after 24 to 48 hours
Source 36
Very severe symptoms
If severe symptoms come on extremely fast, use NHS 111 or go to A&E.
Source 36
Support
The MS Society's helpline is 0808 800 8000.
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Myths
"Exercise makes MS worse or brings on relapses"Strong evidence
NICE says regular exercise doesn't harm MS, and in 40 trials exercise didn't raise the risk of a relapse.
"Feeling worse when you get hot means MS damage"Strong evidence
Heat-related symptoms are "not usually due to new MS damage" and settle within a few hours of cooling down.
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"Pilates is the best exercise for MS"Mixed evidence
In the largest trial, Pilates was no better than relaxation for walking speed, a review found it no better than other therapies, and yoga and water exercise ranked higher for balance and walking in one analysis.
"No pain, no gain"Strong evidence
The MS Trust says that attitude "does not apply in MS", and that it's not a good idea to work through fatigue.
Source 12
"Pilates prevents falls in MS"Mixed evidence
It improves balance tests, but none of the Pilates trials we reviewed counted falls, and the evidence that exercise prevents falls in MS is very low certainty.
"Pilates isn't for wheelchair users"Emerging evidence
Seated Pilates improved sitting balance and posture in wheelchair users with MS, and the MS Society has a free seated Pilates video.
Read next
Questions people ask
Is Pilates good for MS?
Yes, as one good option. NICE says exercise including yoga and Pilates may help MS fatigue, and a 2026 analysis of 22 small trials found better balance and everyday mobility than in control groups, though at low certainty. It hasn't been shown to be better than other exercise.
Does Pilates help MS fatigue?
It may. Home Pilates on DVD reduced fatigue in 80 people with mild MS, and NICE names Pilates for fatigue, but results vary between trials. Stop before you're exhausted: the MS Trust says it's not a good idea to work through fatigue.
Does Pilates help balance and walking in MS?
Balance, mostly yes: Pilates improved balance and the Timed Up and Go test in reviews of small trials. Walking speed didn't improve more than with relaxation in the largest trial, and none of the Pilates trials we reviewed counted falls.
Is Pilates or yoga better for MS?
Neither is clearly better: one study favoured Pilates for walking speed, an analysis ranked yoga first for balance, and online versions of both helped about equally. Choose the one you enjoy and can keep doing, which is also NICE's advice.
Is reformer Pilates good for MS?
In a trial of 38 people, mat and reformer Pilates gave similar gains, with a little more trunk strength from the reformer. Choose whichever you can get to; getting on and off a reformer takes some balance, so ask for help at first.
Can I do Pilates if I use a wheelchair or can't stand for long?
Yes. Seated Pilates improved sitting balance, posture and pain in wheelchair users with MS, and the MS Society has free seated and seated-and-standing Pilates videos. The MS Trust suggests standing when you can, to keep your standing muscles strong.
Is hot Pilates OK with MS?
We'd avoid it: about 6 in 10 people with MS are sensitive to heat, which can bring on symptoms for a few hours. In any class, take cold water and stand near a fan or open window.
How often should I do Pilates with MS?
Twice a week was the most common schedule in the trials, usually for 8 to 12 weeks. Start with about 4 repetitions of each move and add 2 every fortnight, up to 10, and keep up aerobic and strength exercise too.
Can Pilates or exercise cause an MS relapse?
There's no sign that it does: in 40 trials, exercise didn't raise the risk of a relapse, and NICE says regular exercise doesn't harm MS. Symptoms that flare with heat or tiredness usually settle with rest and cooling down.
What if my symptoms get worse during or after Pilates?
Stop, rest and cool down: symptoms brought on by heat should improve within a few hours. If new or worse symptoms last more than 24 hours with no infection or other cause, contact your MS team. Sudden weakness in one arm, loss of vision or problems with balance need 999.
Is a class or home Pilates better for MS?
Supervised Pilates gave bigger gains than the same programme at home in one trial, but home Pilates still helped, and online classes helped in small trials. A neuro-physiotherapist or a teacher who adapts the class for you is ideal.
Can Pilates help bladder problems in MS?
The MS Society lists bladder symptoms among those Pilates can help with, but we found no MS trial that tested it. For bladder control, ask a continence adviser, MS nurse or physiotherapist about pelvic floor exercises; our pelvic floor Pilates guide shows how to add them.
Sources
- NICE NG220 · Multiple sclerosis in adults: management (recommendations, updated August 2026)
- Learmonth 2023 · Safety of exercise training in MS: 40 trials (systematic review and meta-analysis, Mult Scler)
- MS Society · Pilates videos for MS
- Nabil 2026 · Pilates-based programmes in MS: 22 trials (systematic review and network meta-analysis, BMC Sports Sci Med Rehabil)
- Fox 2016 · Pilates, standard exercises or relaxation in 100 people with MS (RCT, Phys Ther)
- Kalron 2017 · Pilates or physical therapy for walking and balance in 45 people with MS (RCT, Clin Rehabil)
- Sánchez-Lastra 2019 · Pilates for people with MS (systematic review and meta-analysis, Mult Scler Relat Disord)
- Fleming 2021 · Home Pilates for anxiety, depression and fatigue in 80 people with MS (RCT, Mult Scler)
- Kalb 2020 · Exercise and physical activity recommendations for people with MS (consensus recommendations, Mult Scler)
- MS Trust · Heat sensitivity and MS (updated July 2026)
- MS Society · MS and exercise (reviewed October 2024)
- MS Trust · Starting to exercise with MS
- NHS · Multiple sclerosis
- MS Trust · Choosing the right exercise (updated February 2025)
- Arik 2022 · Pilates and balance in MS: 8 studies (systematic review and meta-analysis, Mult Scler Relat Disord)
- Rodríguez-Fuentes 2022 · The Pilates method in MS: 20 trials (systematic review, J Clin Med)
- Buttolph 2026 · Mind-body movement for MS symptoms (overview of reviews, Curr Neurol Neurosci Rep)
- Duff 2018 · Pilates and walking in 30 people with MS (RCT, Int J MS Care)
- Abasıyanık 2020 · Clinical Pilates or home exercise in 42 people with MS (RCT, Explore)
- Hayes 2019 · Preventing falls in MS: 13 trials (Cochrane review)
- Hao 2022 · Seven kinds of exercise for balance and walking in MS: 31 trials (network meta-analysis, Int J Environ Res Public Health)
- Abasıyanık 2021 · Yoga or clinical Pilates in 28 people with MS (quasi-experimental study, Explore)
- Najafi 2023 · Online Pilates and online yoga in 45 women with MS (RCT, J Clin Med)
- Najafi 2023 · Online Pilates and yoga in 82 people with relapsing or secondary progressive MS (RCT, Mult Scler Relat Disord)
- Bulguroglu 2017 · Mat and reformer Pilates in 38 people with MS (RCT, NeuroRehabilitation)
- van der Linden 2014 · Pilates for 15 wheelchair users with MS (feasibility study, Disabil Rehabil)
- Adamson 2025 · Online seated Pilates for people with mild to severe MS (pilot trial, Adapt Phys Activ Q)
- Gheitasi 2021 · Pilates and balance in 30 men with MS (RCT, J Bodyw Mov Ther)
- Najafi 2026 · Pilates as therapy for MS: 31 trials (review, Neurodegener Dis Manag)
- Heine 2015 · Exercise therapy for fatigue in MS: 45 trials (Cochrane review)
- Eldemir 2024 · Pilates by video call in 30 people with MS (RCT, Disabil Rehabil)
- Eldemir 2025 · Online Pilates, thinking and dual tasks in 46 people with MS (RCT, Mult Scler Relat Disord)
- Knapova 2025 · Individual Pilates, strength training or online Pilates for back pain in 45 people with MS (trial, Mult Scler Relat Disord)
- Güngör 2022 · Supervised or home Pilates-based core training in 50 people with MS (RCT, Mult Scler)
- Fleming 2022 · Experiences of supervised or home Pilates in MS (qualitative study, Disabil Rehabil)
- MS Trust · MS relapses and their management (updated August 2026)
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.