Pilates guide
Pilates is slow, deliberate exercise for strength, balance and posture, and Parkinson's UK lists it among the classes a physiotherapist may suggest. In small trials of people with mild to moderate Parkinson's, it improved leg strength, balance and walking tests, sometimes more than other exercise. It hasn't been shown to slow Parkinson's, and the gains faded when classes stopped.
Pilates is an addition to your medicines and to a physiotherapist who knows Parkinson's, never a replacement for them. Most kinds of exercise help about as much, so choose what you enjoy and keep it going, alongside walking or cycling.
This guide covers what the trials show, how Pilates compares with other exercise, balance, falls and freezing, posture, dizziness when you stand up, getting down to the floor and up again, which moves to start with and which to leave out, and a 25-minute chair, counter and mat class.
Parkinson's UK names Pilates among the classes a physiotherapist may suggest, and says "Other techniques, such as Pilates, can also help". The National Institute for Health and Care Excellence (NICE) recommends seeing a physiotherapist who knows Parkinson's early on. Pilates adds to your medicines and that care; it doesn't replace them, and it hasn't been shown to slow Parkinson's.
In 4 small randomised trials, Pilates improved standing up from a chair and a walking test more than other training, but the studies were of poor to fair quality and their results varied widely. Two later trials of 40 and 32 people found better balance on the move than standard physiotherapy.
In three small studies, some improvements had slipped back within 4 weeks to 3 months of the classes ending. Pilates helps while you keep doing it.
A Cochrane review of 154 trials found most kinds of exercise helped movement and quality of life, with little evidence that one beats another; none of the trials in its analyses tested Pilates. Parkinson's UK suggests building to 2.5 hours of activity a week.
Across 12 trials, exercise cut the rate of falls by about a quarter. International falls guidelines strongly recommend balance and strength training in early to mid-stage Parkinson's, and supervision by a physiotherapist in complex Parkinson's. No Pilates trial has counted falls.
Pump your feet before you stand up from the mat, and practise getting down to the floor and up again only with someone there. If getting down isn't safe yet, do Pilates sitting and standing.
Parkinson's is a long-term condition of the brain that causes slowness, stiffness and tremor, and often balance problems. The NHS lists balance problems that make falls more likely, and dizziness or fainting when you stand up, among its symptoms. Medicines treat the symptoms, and a physiotherapist can help with stiffness, walking and flexibility through movement and exercise.
NICE recommends considering referral early to a physiotherapist with Parkinson's experience, Parkinson's-specific physiotherapy for balance or movement problems, and considering the Alexander Technique; it doesn't mention Pilates. Parkinson's UK says activity "can be as important as getting the right dose of medication", starting with 30 minutes of aerobic activity twice a week and 10 to 20 minutes of stretching a day, and building towards 30 minutes, 5 times a week. The NHS suggests less strenuous activity, such as walking and simple strengthening, if your symptoms are complex or progressing.
Pilates is low-impact, controlled exercise done mostly lying, sitting and kneeling. Two physiotherapists writing for Parkinson's UK describe its principles (concentration, breathing, core control, precision and smooth flow) as helpful for people with Parkinson's, because it "focuses on how well each movement is performed, not on speed".
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People with mild to moderate Parkinson's (stages 1 to 3 on the Hoehn and Yahr scale) who could stand and walk without help. Whether the results apply to more advanced Parkinson's isn't known.
A 2019 review found 4 randomised trials and 4 other studies, of poor to fair quality, mostly of mat Pilates for 6 to 12 weeks, 2 or 3 times a week. Pooling the randomised trials (112 people), Pilates improved a 30-second chair-stand test and a timed walking test more than other training. The chair-stand estimate's confidence interval crossed zero, and the trials varied a lot, so the size of the benefit is uncertain.
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In 40 people, clinical Pilates (Pilates taught by a physiotherapist) twice a week for 8 weeks was as effective as standard physiotherapy, with better balance on the move. In 32 people, 12 weeks of a Pilates programme improved walking, balance and reaction time more than physiotherapy; movement scores were similar, and 3 months later most differences had narrowed. Each is a single small trial.
In one trial of 35 people, 12 weeks of mat Pilates twice a week improved fitness, leg strength, low mood and anxiety within the Pilates group, while the group that didn't exercise got weaker. Mat Pilates and a mixed exercise programme both improved walking speed over 20 weeks in 34 people. Small studies also found better core endurance.
In 26 people, balance and leg-strength gains from 12 weeks of mat Pilates weren't kept 4 weeks after classes stopped. A 2026 review of follow-up studies found balance and walking gains from several kinds of exercise, Pilates among them, lasting 3 months or more, at low to moderate certainty. Keeping going is the safest bet.
Analyses that compare many exercise types indirectly ranked Pilates first for some balance and mobility tests, in reviews of 60 to 199 studies. The confidence in these rankings was often low, and other analyses put dance, tai chi or treadmill training first for other tests.
One 2026 network analysis, seen as an abstract only, with an estimate far larger than Cochrane's, reported that Pilates lowered a movement symptom score by about 13 points compared with control groups. Cochrane's estimates for the main exercise types were about 4 to 10 points. Treat that one figure with caution.
In the studies that reported it, side effects were few and mild: tiredness, muscle soreness, cramps and, in one person, mild dizziness. Half the studies in the review didn't report side effects at all.
A 2025 review found the Pilates studies too small, often not randomised, poorly described and varied in dose. It found no evidence that Pilates is better than other exercise. Our search found no Pilates trial that counted falls.
Cochrane's review of 154 trials (7,837 people, mostly mild to moderate Parkinson's) found dance and balance, walking and functional training probably improve movement symptoms moderately, and aerobic, water-based, strength and mind-body training (such as tai chi and yoga) might improve them a little, with "little evidence of differences" between them. None of the trials in its analyses tested Pilates.
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The European physiotherapy guideline for Parkinson's recommends physiotherapy-led exercise (at least 8 weeks, three 45-minute sessions a week), treadmill training, cueing, dance and tai chi. It doesn't name Pilates.
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Pilates suits strength, control and posture work. Add walking, cycling or another activity that makes you breathe harder: Parkinson's UK says activity works best when it challenges you. Our exercise for Parkinson's guide covers aerobic exercise, boxing and big-movement training.
Our Pilates for balance guide covers balance work for everyone.
Across 12 trials of 1,456 people with mild to moderate Parkinson's, exercise probably cut the rate of falls by about 26% and slightly reduced the number of people who fell (moderate certainty). Whether it prevents broken bones is uncertain.
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International guidelines strongly recommend individual balance and strength training in early to mid-stage Parkinson's with mild or no memory problems. In complex Parkinson's, they recommend exercise only with a physiotherapist or other qualified professional supervising, because limited data suggest exercise with little supervision may increase falls.
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In studies that followed people over time, 38% to 54% fell within 3 months and 68% within a year, and people with Parkinson's are more likely to have thin bones. After any fall, Parkinson's UK says to see your GP so they can look for the cause.
"Over half of people with Parkinson's may experience freezing": your feet feel stuck, most often as you start to walk, turn or go through a doorway. If you freeze in class, stop, shift your weight onto one leg and restart to a count such as "one, two, three, step".
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Pilates improved balance tests in small trials, but our search found no Pilates trial that counted falls. Do your balance work beside a counter.
In 811 people with Parkinson's, about 1 in 5 had a stooped or leaning posture: bending forward at the hips or lower back (11%), leaning to one side (8%) or the head dropping forward (7%). It was more common with longer, more advanced Parkinson's, and went with more falls and back pain. The causes are mixed, including stiffness, muscle weakness and a changed sense of where your body is.
Long-term stooping weakens the muscles along the back, neck and hips, so back extension work makes sense. But the European physiotherapy guideline says stooping may partly protect against falling backwards, and people who "actively adopt an upright posture may become more unstable".
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Train posture lying face down and sitting (the swan, swimming and upper-back lifts), stretch the front of your chest, and ask your physiotherapist about posture when you stand and walk. A stoop or lean that is new or getting worse needs your specialist (our suggestion).
Across 25 studies, about 3 in 10 people with Parkinson's had low blood pressure on standing, though the studies varied a lot. Parkinson's UK calls it a common cause of falls, and says some people also have high blood pressure when lying down.
Parkinson's UK suggests pumping your feet up and down 10 times, bending forwards and backwards from your hips, squeezing your fists, marching gently or crossing and uncrossing your legs before you stand. Then get up slowly, and stand still until you feel steady, holding something if you need to.
"If you feel dizzy or that you might faint, sit with your legs raised or lie down until the feeling passes." Tell your GP, specialist or Parkinson's nurse. Avoid exercising when it's too hot.
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If you've been told you have high blood pressure when lying flat (supine hypertension), Parkinson's UK says "Avoid lying down during the day". Keep lying-down blocks short and rest sitting up (our suggestion).
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The European physiotherapy guideline includes standing up from, and sitting down onto, the floor among its exercises, but advises against practising how to fall. Parkinson's UK says a physiotherapist can teach you "to get down on to the floor and back up safely".
Take your time, then:
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Practise with someone present and a sturdy chair close by. If getting down isn't safe yet, do the class sitting and standing, and ask your physiotherapist to teach you.
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The trials used 2 or 3 sessions a week of 45 to 60 minutes for 6 to 20 weeks. In expert advice from Parkinson's UK, two physiotherapists suggest "around 15 to 30 minutes of tailored exercise, 4 times weekly".
Our editorial starting point, built on the trials and Parkinson's UK's advice:
Start here, and come back here on harder days: 5 to 8 breaths, 1 to 2 minutes of marching, 3 to 5 upper-back lifts held 3 to 5 seconds and 6 turns each side are the move pages' doses.
Keep a counter within reach. Our editorial starting point: 2 sets of 5 sit-to-stands, 1 minute of marching to a beat, 10 calf raises and 2 holds of 15 seconds in semi-tandem (the last three as in our Parkinson's routine); 10 side-steps each way and 5 spiral reaches each side are within the move pages' doses.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoStanding marchBeginner · No equipment
3D demoSide-stepping (sideways walking)Beginner · A wall
3D demoStanding spiral reachBeginner · No equipment
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoSlow calf raiseBeginner · A wall
3D demoSemi-tandem stanceBeginner · A wall
3D demoSingle-leg standBeginner · A wallWith someone nearby and a sturdy chair, one slow cycle down to the mat at the start and two at the end (our editorial starting point, fewer than the move page's). Then 5 small swans, 8 side kicks each side and two 20-second sets of swimming (within the move pages' doses), and 5 or 6 of each of the others (our editorial starting point).
3D demoGet up and down from the floorBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoDead bug heel tapsBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipmentOur editorial starting point, as in our Parkinson's routine: 8 slow wall angels, 5 chin tucks held 5 seconds, and 2 holds of 30 seconds each side in the doorway.
Leave out the roll-up, rolling like a ball, roll-over, jack knife, teaser and similar moves. People with Parkinson's are more likely to have thin bones, the UK osteoporosis advice suggests alternatives to rolling and rounding the spine under load, and head-down positions can bring on dizziness (our reading).
In the hundred and the leg stretches, keep your head down on the mat if you have thin bones or a stooped neck.
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Only next to support. Skip them if you fall often or freeze, and turn in a wide half-circle rather than pivoting.
With high blood pressure when lying down, keep them short and rest sitting up.
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Do the 25-minute class two or three times a week. On days when standing is hard, use the seated chair class; the Parkinson's routine adds big-movement and boxing-style work.
A 25-minute Pilates class for Parkinson's: seated breathing and posture, big standing movements at a counter, balance work and an optional mat and floor block.
25 minBeginner21 movesA bench or box, A wallA 35-minute home routine for Parkinson's: big steps to a beat, boxing-style punches, strength moves and balance at a counter, then posture stretches.
35 minBeginner18 movesCardio machine, A wallA 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 20-minute chair Pilates workout for beginners and older adults: breathing, sitting tall, gentle spine and leg moves, and a standing finish at the chair.
20 minBeginner14 movesA bench or box, Something with weightA 15-minute chair Pilates class done entirely sitting down, in a chair or wheelchair: breathing, spine moves, and leg and arm strength with water bottles.
15 minBeginner13 movesA bench or box, Something with weightA 30-minute yoga class for Parkinson's: seated breathing and big movements, standing poses at a kitchen counter, stepping and turning, then posture stretches.
30 minBeginner20 movesA bench or box, A wallThe seniors plan adds walking and strength work around your Pilates; the beginner plan builds a Pilates habit.
A 12-week exercise plan for over-65s: strength and balance three times a week, short balance sessions and daily walks, based on falls-prevention trials.
3 training days40 minBeginner3 days a weekA free 4-week, 3-day Pilates plan for complete beginners. Two mat days and one wall day, with clear rules for when to move each exercise to its harder version.
3 training days25 minBeginnerCall 999 (911 in the US) if:
Call 999 if:
Call 999 if someone has hit their head and has been knocked out and hasn't woken, can't stay awake, has a fit, has problems with their vision or hearing, has clear fluid from their ears or nose, or has new numbness, weakness or problems walking, balancing or speaking.
Call 111: If you've fallen and may be in pain, hurt or unwell; or you've hit your head and you take medicine that thins your blood (or have a condition that does), or you're being sick or feel dizzy. Don't drive yourself to A&E (accident and emergency) after a head injury.
Call NHS 111 or your Parkinson's nurse if you have fallen and may be in pain, injured or unwell. Get urgent advice too if your symptoms suddenly get much worse, for example you suddenly can't move or are far stiffer than usual (our suggestion).
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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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Stop and sit with your legs raised, or lie down, if you feel dizzy or faint, and wait until it passes. Stop, too, for chest pain, unusual breathlessness or a pounding or irregular heartbeat (our suggestion, as in our heart disease guide).
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Parkinson's UK helpline: 0808 800 0303.
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Not shown. No Pilates trial measured whether Parkinson's progressed; they measured balance, walking and strength over weeks, and the gains faded when classes stopped. Exercise in general improves symptoms, but no trial shows it slows the disease.
The opposite: exercise cut the rate of falls by about a quarter, and guidelines strongly recommend balance and strength training. Change the set-up, with support in reach and a physiotherapist in complex Parkinson's, not the plan to exercise.
Not shown. Some comparisons rank Pilates first for some balance tests at low certainty, others rank dance or tai chi first, and Cochrane found little difference between exercise types.
Strengthening your back may help, but forcing an upright posture can make some people less stable. Work on posture lying and sitting, and let your physiotherapist guide how you walk.
Parkinson's UK says being active works best "when you push yourself", and suggests building to moderate or high-intensity aerobic activity. Pilates is one part of the week.
Nearly all the Parkinson's trials used mat Pilates; one small study used equipment. Getting on and off a reformer takes balance, so have help at first.
It can be: in small trials, Pilates improved leg strength, balance and walking tests in people with mild to moderate Parkinson's, and Parkinson's UK lists it among the classes a physiotherapist may suggest. The trials are small and the gains faded when classes stopped, so treat it as one regular part of your week, alongside your medicines and physiotherapy.
No trial has shown that Pilates, or any exercise, slows Parkinson's. It can help how you move and feel while you keep doing it.
Not as far as anyone can tell. A Cochrane review of 154 trials found most exercise helps and little difference between types, and none of the trials in its analyses tested Pilates. Choose what you enjoy and will keep doing, and add walking or cycling.
Pilates improved balance tests in small trials, and exercise in general cuts the rate of falls by about a quarter. No Pilates trial has counted falls, so do your balance work beside a counter, and see your GP after any fall.
Strengthening the muscles along your back may help, and the swan, swimming and upper-back lifts train them. Don't force yourself rigidly upright when you walk, which can make balance worse for some people; ask your physiotherapist about posture when standing and walking.
Almost all the trials used mat Pilates, and nobody has compared the two. Getting on and off a reformer takes balance, so have help at first.
Pump your feet up and down 10 times and sit for a moment before standing, then stand slowly with something to hold. If you feel faint, sit with your legs raised or lie down until it passes, and tell your GP or Parkinson's nurse, who can check your blood pressure lying, sitting and standing.
Stop, take a breath, shift your weight onto one leg and restart to a count such as "one, two, three, step". Do standing work beside a counter and turn in a wide half-circle.
If you can do it safely, yes: the European physiotherapy guideline includes getting down to and up from the floor, and a physiotherapist can teach you. Practise with someone there and a sturdy chair; if it isn't safe yet, do Pilates sitting and standing.
The trials used 2 or 3 sessions a week for 6 to 20 weeks, and two physiotherapists writing for Parkinson's UK suggest 15 to 30 minutes, 4 times a week. Keep going: the benefits faded when people stopped.
Neither has been shown to be better overall. Pilates suits strength, control and posture; our yoga for Parkinson's guide covers yoga.
Call 999 if someone falls and may have hurt their head, neck, back or hip, or can't get up, or for chest pain, fainting or signs of a stroke. See your GP after any fall, and ask for a Parkinson's physiotherapist if you haven't seen one.
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.
