Pilates guide
Polymyalgia rheumatica (PMR) makes the shoulders, neck and hips stiff and achy, worst in the morning, mostly in people over 65. Moving usually eases it, and the PMR charity's exercise booklet suggests trying Pilates. No study has tested Pilates, or any exercise programme, in PMR yet, so this guide uses the UK and European guidelines, that booklet and research on exercise in older adults and in people taking steroids.
Steroids treat PMR; Pilates doesn't, and it never replaces them. This guide starts with the giant cell arteritis signs that need urgent help, then covers seated moves for stiff mornings, strength and balance at a chair, bone-safe swaps while you take steroids, pacing and flare days, and the classes to follow. Our exercise for polymyalgia rheumatica guide has the full exercise plan; this page fits Pilates into it.
This is general information, not a diagnosis. A&E means accident and emergency. In the US, call 911 where this page says 999, and get same-day medical care where it says NHS 111.
Call 999 or go to A&E if any of these happen. Don't drive yourself: ask someone to drive you, or call 999 for an ambulance.
The NHS says to contact a GP or call NHS 111 immediately if you've been diagnosed with polymyalgia rheumatica, or it's suspected, and you have:
In the NHS's words: "Unlike polymyalgia rheumatica, temporal arteritis requires immediate medical attention. It can lead to serious problems like stroke or blindness if not treated quickly." Temporal arteritis is another name for giant cell arteritis. If it affects your sight, the NHS says you should have a same-day appointment with an eye specialist at a hospital eye department, and treatment starts before the diagnosis is confirmed.
The 2026 UK guideline adds that "symptoms or signs of GCA, especially if there are new visual symptoms, require same-day assessment by a specialist" (GCA is giant cell arteritis), and the UK guideline on giant cell arteritis says: "GCA is a medical emergency."
The charity PMRGCAuk says sudden changes in your sight need a doctor the same day even if they only last a few minutes, and if you can't see your doctor, go to A&E. Arthritis UK says that if you can't get an immediate appointment, contact an out-of-hours doctor or go to A&E straight away. Less often, giant cell arteritis causes pain in the arm muscles when you use them, or in the calves when you walk. In Scotland, NHS inform says to phone 111 or your GP practice urgently, and for sudden changes in your vision, to contact an optician immediately or phone 111.
It depends on the source. The NHS says up to 1 in 5 people with PMR develop giant cell arteritis; the 2026 UK guideline from the British Society for Rheumatology (BSR) and the charity PMRGCAuk say about 5% to 10%; and in a review of scan studies, about a quarter (23%) of people newly diagnosed with PMR had signs of giant cell arteritis on scans without its symptoms. Arthritis UK says about half of people with giant cell arteritis may also have symptoms of PMR. Whatever the figure, the signs above always need urgent help, during a Pilates class too.
Prednisolone, a steroid, "does not cure polymyalgia rheumatica, but it can help relieve the symptoms", usually over about 2 years. Never stop or change the dose yourself. Pilates sits beside your GP and rheumatology team, never instead.
The UK guideline says "the evidence for exercise specifically in PMR is lacking" and expects research from other conditions to apply. A 2026 European review found no exercise trial in PMR, and our searches found no study of Pilates. So the amounts here are expert and patient advice.
The 2026 UK guideline wants everyone given advice on physical activity and pacing, and the 2015 European and American recommendations conditionally recommend an individual exercise programme to keep muscle and function and cut falls. The PMR charity's booklet suggests trying Pilates.
The booklet's stretches go as far as is comfortable, held for up to 20 seconds, 5 of each, at least twice a day. Once symptoms are controlled, strength and balance build from 5 to 20 repetitions over a month. Chair Pilates fits both.
In UK records, the risk of breaking a bone was 63% higher in people with PMR, and it's highest in the first year of steroids. Swap rounding and rolling moves for hip hinges and smooth twists.
Steroids can cause painless weakness in the thigh and shoulder muscles, and in other conditions, exercise improved muscle strength in people taking steroids. Pilates alone builds little strength in older adults, so add sit-to-stands and light weights, starting at about half your earlier level of activity.
The NHS: "The main symptom is muscle stiffness in the morning that lasts longer than 45 minutes." Pain and stiffness are around the shoulders, neck and hips, usually on both sides, and the stiffness "usually starts to improve after about 45 minutes as you become more active". Arthritis UK: it "is worse when resting or after rest." Some people also feel very tired, lose their appetite or weight, or feel low. Most people diagnosed are over 65 (NHS inform says over 70), and it's more common in women; the UK guideline says "PMR is most commonly diagnosed in people over the age of 50".
"You'll probably need to continue taking a low dose of prednisolone for about 2 years." The dose is usually reduced every 1 to 2 months. The UK guideline says "The other 50% of people with PMR follow a relapsing course", and in a review of studies, about half of people were still taking steroids after 2 years and a quarter after 5.
Steroid muscle weakness "typically affects the proximal skeletal muscles and is characterised by pain-free weakness and muscle atrophy which affects physical performance" (the muscles nearest the trunk, such as the thighs and shoulders; atrophy means wasting). In an Australian study, women with PMR were about 3 seconds slower at standing up from a chair 5 times than women without it, 18 months in. In a US study of 41 people with PMR, 17% were frail and 59% on the way to it.
The UK guideline reports "around 85% of people with PMR experiencing GC-related toxicity" (GC means glucocorticoid, the family of steroids prednisolone belongs to; toxicity means side effects). In an Italian study of 222 people on long-term low-dose steroids, 43% had at least 1 side effect, mostly after 2 years, and a review found 6% of people with PMR developed diabetes, against about 4.8% expected. But in a US study of 359 people, only cataracts were more common than in people of the same age without PMR. The studies disagree, so ask your team what to watch for.
Prednisolone increases appetite, "which often leads to weight gain", and in interviews, people with PMR said changes in their weight and face shape mattered to them. PMRGCAuk advises: "Don't skip meals, starve yourself or crash diet in an effort to deal with steroid-related weight gain."
Mat classes start lying down and get up and down from the floor; many classical moves round the spine under load (the roll-up, the hundred and curl-ups held with the head up) or roll onto it; some take the arms overhead in long holds; and morning classes meet the worst of the stiffness (our reading). With PMR these meet stiff shoulders and hips, steroid-thinned bones and weaker thighs. A chair class later in the morning, with hip hinges instead of rounding, arms only as high as is comfortable, and strength and balance at the chair, fits what the guideline asks for.
"Overall, the evidence for exercise specifically in PMR is lacking" (the 2026 UK guideline). The 2026 European evidence review included 141 studies, and its 13 PMR trials were all of medicines. Our searches found no study of Pilates, yoga or tai chi in PMR or giant cell arteritis.
The first registered rehabilitation trial in PMR, a feasibility trial of 20 people in the USA practising everyday movements such as getting out of bed and reaching overhead, started recruiting in August 2026 and has no results yet. It isn't Pilates.
The UK guideline: "People with PMR should have access to educational material and support including information on self-care such as diet, physical activity and pacing." (97% of its panel agreed). The 2015 recommendations of the European League Against Rheumatism (EULAR) and the American College of Rheumatology, which we read in full, say: "The panel conditionally recommends considering an individualised exercise programme for PMR patients aimed at the maintenance of muscle mass and function, and reducing risk of falls". They add that "There are no studies investigating the value of non-pharmacological therapies", so the recommendation rests on expert opinion.
The 2026 German, Austrian and Swiss guideline: "Older and frail patients should also be offered an individualized exercise program." The summary of EULAR's 2025 update doesn't mention exercise, and we couldn't read its full text.
The UK guideline's table: strength "Counteracts GC-induced myopathy, reduces sarcopenia and improves bone health" (myopathy means muscle weakness; sarcopenia means muscle loss), balance "Reduces the risk of falls, especially important in those at higher risk of fractures", and stretching "Maintains/recovers reduced range of movement and flexibility". It wants muscle strengthening and a review of falls risk to start soon after diagnosis.
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A 2026 review of 18 trials in 663 people taking steroids, mostly for rheumatoid arthritis and lupus: "Exercise interventions consistently improved muscle performance and functional outcomes, whereas evidence regarding bone, cardiometabolic, cognitive, and mental health outcomes was limited or inconsistent." It calls progressive resistance training "the first-line intervention for managing glucocorticoid-induced myopathy". In 12 people taking prednisone, a similar steroid, 50 days of training restored thigh muscle and strength. None of these people had PMR.
In 47 older people (6 with fibromyalgia rather than PMR), everyone did "as many stand ups as possible twice a day" for two 8-week periods while testing two dairy drinks. Walking speed rose 5.3% and chair stands improved 12.2%, but nobody went without the stand-ups, so the gains can't be credited to them, and a dairy company helped fund the trial.
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In older adults, Pilates didn't significantly build strength against no exercise, at low certainty. In people at higher risk of fracture, a review of 5 small studies found "low-certainty evidence that Pilates improved physical functioning and health-related quality of life", with its effect on falls and bone density uncertain, and pooled, Pilates and yoga didn't improve bone density in women. In 30 people with rheumatoid arthritis, Pilates, walking and both together improved some measures, with no difference between them. So Pilates suits the stretching, balance and some of the strength work, with heavier strength training for the thighs and bones alongside (our reading).
In 59 trials of older people living at home, exercise cut the rate of falls by 23%, at high certainty. These weren't PMR trials, but falls matter more when steroids have thinned the bones, which is why the UK guideline wants falls risk reviewed soon after diagnosis.
In a UK study of 197 people with PMR, "only 35 (17%) report using exercise to manage their PMR and 50 (25%) report receiving specific exercise advice from a clinician." Of those who used exercise, 85% reported benefit. In a survey of 1,072 UK physiotherapists, 80% saw a role for physiotherapy in PMR, and 89% prescribed graded exercise, starting with the arms and shoulders. In interviews, people described "profound disability" and challenged "the myth of full resolution of symptoms with steroid treatment", and in an Australian study, fatigue and poor sleep lasted almost 2 years.
Starting points to discuss with your GP or a physiotherapist. The booklet's amounts are expert and patient advice; they haven't been tested in a trial.
The booklet: "Try to stretch as far as you comfortably can, holding the same movement for up to 20 seconds." Start with 5 of each, at least twice a day.
Source 17
"Start by repeating each intermediate exercise x5, slowly building up over a month to 20 repetitions every day". The UK guideline wants muscle strengthening and a review of falls risk to start soon after diagnosis.
A chair Pilates class 2 or 3 times a week, plus the booklet's short stretches on other days, is our editorial starting point, built up from about half your earlier level of activity. The booklet: "Keep doing all activities you enjoy e.g., swimming, golf, yoga, Pilates etc, but if you find something particularly difficult, ask the teacher/ instructor for alternatives."
Do Pilates later in the morning, once the stiffness eases, or after a warm bath or shower. Arthritis UK: "Simple measures such as a hot bath or shower can help to ease pain and stiffness, either first thing in the morning or after exercise."
"Walking is usually the most suitable weight-bearing exercise for people with polymyalgia rheumatica." Pilates goes alongside it.
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Later in the morning or after a warm shower, arms only as high as is comfortable. Lateral breathing, sitting: "5 to 8 breaths at the start of every session", from the move page's dose. Neck turns, left and right only: 5 slow turns each way, holding up to 20 seconds; stop if you feel dizzy. Shoulder rolls: 5 slow shrugs. Elbow opening with your hands behind your head: 5 times, holding up to 20 seconds. Single knee to chest, sitting: 5 each side, holding up to 20 seconds (those four are our polymyalgia rheumatica routine, from the booklet). Breath reach: "5 breaths, exhale longer than inhale", the move page's dose. Thoracic rotation, seated: 5 each side with 5-second holds; table slide: 8 to 10 slow reps, the bone-friendly swap for rounding forward (our chair Pilates workout). Seated upper-back lift: "3 to 5 repetitions, each held 3 to 5 seconds, at least twice a week (UK osteoporosis consensus, 2022)", from the move page's dose.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoNeck CARs (controlled articular rotations)Beginner · No equipment
3D demoShoulder rollsBeginner · No equipment
3D demoElbow opening with hands behind the headBeginner · No equipment
3D demoSingle knee-to-chest stretchBeginner · No equipment
3D demoBreath reachBeginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoTable slide (seated forward reach)Beginner · A bench or box
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or boxSit to stand: 5, building over a month to 20 (our polymyalgia rheumatica routine, from the booklet); these are the thigh muscles steroids weaken first. Standing march: 1 minute, holding the back of the chair; slow calf raise: 8 to 10, holding the chair; wall side leg lift: 8 each side, hand on the chair (our chair Pilates workout). Standing hip extension: 5 each leg, holding 5 to 10 seconds, no band to start; semi-tandem stance: up to 10 seconds each side, building to 30, fingertips on a counter (our polymyalgia rheumatica routine). Side-stepping: "10 steps each way, next to a counter (the NHS balance exercises)", from the move page's dose.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoStanding marchBeginner · No equipment
3D demoSlow calf raiseBeginner · A wall
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoStanding band hip extensionBeginner · A band + An anchor point
3D demoSemi-tandem stanceBeginner · A wall
3D demoSide-stepping (sideways walking)Beginner · A wallThe bone-safe versions from our Pilates for osteoporosis class, which follows the Royal Osteoporosis Society's swaps. Knee fold: "2 sets of 5 to 10 each side, every other day", from the move page's dose, head down: the swap for the hundred and curl-ups. Pelvic tilt into bridge: 6 to 8 slow reps, lifting part of the way; side kick: 8 each side, head resting on your arm; swan: 3 to 5 small lifts, each held 3 to 5 seconds; swimming as slow opposite arm and leg lifts: 3 to 5 each side, each held 3 to 5 seconds; single-leg circle: 5 each direction, each leg, bottom knee bent and small (our Pilates for osteoporosis class). On stiff days, stay in the chair (our suggestion).
3D demoKnee foldBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · 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 demoSingle-leg circle (Pilates one leg circle)Beginner · No equipmentSteroids raise the risk of a broken bone most in the first year, so swap these, as the move pages already do for osteoporosis. Rounding moves, especially loaded or repeated: the roll-up, the spine stretch forward (sit tall and hinge instead), the saw (twist without rounding), the roll-down (use the wall roll-down with your hands on your thighs) and the half roll back. Curl-ups held with the head up: the hundred (head down, as its page says), the chest lift and the scissors (use the knee fold). Rolling and legs-overhead moves: rolling like a ball, the open-leg rocker, the roll-over, the jack knife, the teaser and the neck pull. With stiff shoulders, reach only as high as is comfortable in long holds.
3D demoRoll-up (Pilates)Intermediate · No equipment
3D demoSpine stretch forward (Pilates spine stretch)Beginner · No equipment
3D demoSaw (Pilates)Intermediate · No equipment
3D demoSegmental roll-downIntermediate · No equipment
3D demoHalf roll back (Pilates C-curve roll back)Beginner · No equipment
3D demoHundred (Pilates)Intermediate · No equipment
3D demoChest lift (Pilates curl-up)Beginner · No equipment
3D demoSingle straight-leg stretch (Pilates scissors)Intermediate · No equipment
3D demoRolling like a ball (Pilates rolling back)Intermediate · No equipment
3D demoOpen-leg rocker (Pilates rocker with open legs)Advanced · No equipment
3D demoRoll-over (Pilates roll-over with legs spread)Advanced · No equipment
3D demoJack knife (Pilates)Advanced · No equipment
3D demoTeaser (Pilates)Advanced · No equipment
3D demoNeck pull (Pilates)Advanced · No equipmentIn UK records of 12,136 people with PMR, "Risk of fracture was increased by 63% in PMR", and the UK guideline says "by 5 years from diagnosis, 9.5% of individuals with PMR had sustained a fracture". It now says: "Prescribe bisphosphonates for people with PMR starting glucocorticoid therapy unless contraindicated." (bisphosphonates are bone-protecting medicines). Even low doses thinned the spine: in 19 people with PMR taking about 6 mg a day, bone density in the lower back fell 2.6%, and the Royal Osteoporosis Society notes that "even a low dose (for example, 2.5 to 7.5mg of prednisolone per day) may increase your risk of breaking a bone". In one PMR study, a past fall was the factor most strongly linked with a broken bone.
The UK osteoporosis guideline says "repetitive forced spinal forward flexion exercises should be undertaken with care", and the Royal Osteoporosis Society says to "use the hip hinge to bend safely." Our osteoporosis lines:
Modify or avoid exercises that round your back deeply or repeatedly, especially with a weight: sit-ups, toe touches, Pilates roll-downs and curl-ups, and extreme yoga forward folds. Bend from the hips instead. You do not need to avoid bending, twisting or lifting altogether: move smoothly and keep your upper back straight.
Twisting should be safe if you do it smoothly and comfortably. Slow down and shorten fast or forceful twists, and leave out the added weight.
Strength work is the answer the evidence points to: progressive resistance training was the first-line treatment in a review of people taking steroids. Pilates on its own builds little strength in older adults, so add sit-to-stands, step-ups and light weights, building over weeks. Tell your team about new weakness, because it can be hard to tell apart from PMR.
Pooled, Pilates and yoga didn't improve bone density in women, and in people at higher risk of fracture, Pilates' effect on bone density was uncertain. Bone medicine, walking and progressive strength training do that job, and Pilates helps with balance alongside them.
"Do not suddenly stop taking steroid medicine unless your doctor tells you it's safe to stop. Suddenly stopping treatment with steroids can make you very unwell."
Stopping suddenly can make you very unwell. If you take steroids for more than 3 weeks, your GP or pharmacist should give you a steroid card to carry. If you're ill and being sick, follow the steroid sick day rules your team gave you.
PMRGCAuk's rule of thumb: "think of your earlier level of activity or sport, and then think of half of that". People who go straight back to their old routine often "feel pretty rough" the next day, with the aching and stiffness back.
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Arthritis UK: "Too much exercise is likely to make your symptoms worse, but activity usually helps to ease pain and stiffness in the muscles of the shoulders, hips and thighs."
Source 24
If you ache, "Try halving the amount you did." "Don't be tempted to do more than you had planned, even if you are having a good day." "Expect setbacks and times when your symptoms seem worse; this is normal with PMR."
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The UK guideline says "patients tapering GCs can experience withdrawal symptoms, including arthralgia and fatigue" (joint pain and tiredness), which can be hard to tell from a flare. Cut back for a while rather than stopping.
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Never stop or change your steroid dose yourself. If your PMR symptoms come back as the dose comes down, contact your GP or rheumatology team, and keep moving gently in the meantime.
Start with the polymyalgia rheumatica routine's stretches, twice a day; our exercise guide owns it. The chair Pilates workout is the main Pilates class, seated and then standing at the chair, with a hip hinge instead of rounding forward and the back-strengthening holds the bone guidance recommends. Three cues from us: do it later in the morning or after a warm shower; reach only as high as is comfortable in the side bend and the breath reach; and on stiff days, do only the seated half. Use the 15-minute seated class on flare days, the osteoporosis mat class once getting down and up is comfortable, and the balance class for standing balance.
The stretches and light strength moves from a polymyalgia rheumatica self-help booklet written with patients, plus balance practice, built up slowly.
15 minBeginner15 movesDumbbell, 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 movesBench 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 movesBench or box, something with weightA 25-minute Pilates workout for osteoporosis and osteopenia: the Royal Osteoporosis Society's swaps for rounding moves, plus back strength and balance.
25 minBeginner16 movesWall, bench or boxA 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 movesWall, bench or boxA 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 movesWallFor building up walking and strength over several weeks, once your symptoms are controlled, as our exercise guide suggests.
A 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 minBeginner3 days a weekA 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 minBeginnerThe giant cell arteritis signs are at the top of this page. This is general information, not a diagnosis. A&E means accident and emergency. In the US, call 911 where this page says 999, and get same-day medical care where it says NHS 111.
Call 999, and don't drive yourself to A&E, for:
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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The NHS lists these as possible serious side effects of prednisolone. Call NHS 111 if you think you have one, or if you're having thoughts of harming yourself:
Sudden new back pain, often after a bend, lift, cough or minor fall, or new height loss or a change in the curve of your upper back. These can be signs of a spinal fracture, and not all spinal fractures hurt.
See your doctor about unexplained back pain, especially in the upper back, or a change in body shape such as losing height or a more curved back. These can be signs of a spinal fracture, though not all spinal fractures hurt. Our lower back pain after Pilates guide covers back pain after a class, with the swaps for thin bones.
Tell the teacher you have PMR and take steroids. Leave out the moves that round the spine under load or roll onto it, because steroids thin bones fastest in the first year; keep your arms at or below a comfortable height; and say no to hands-on pushing into a stiff shoulder or hip.
See a GP if you have pain and stiffness for more than a week, especially if you're over 50, it's in both shoulders (often the neck and hips too) and the stiffness lasts longer than 45 minutes in the morning. It can be polymyalgia rheumatica.
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PMRGCAuk's helpline, answered by volunteers who have had PMR or giant cell arteritis, is on 0300 111 5090, Monday to Friday, 9am to 5pm; it can't give medical advice. Arthritis UK's helpline is on 0800 5200 520.
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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No study has tested Pilates in PMR. Steroids treat it, and stopping them suddenly can make you very unwell.
Activity "usually helps to ease pain and stiffness", the UK guideline wants everyone given advice on physical activity and pacing, and the European and American recommendations support an individual exercise programme, though no trial has tested one.
Doing too much can bring the aching back for a day or so, which is why the advice is about half your earlier level. Symptoms that come back as the dose comes down are the PMR returning, and need your GP or team.
In people taking steroids for other conditions, exercise improved muscle performance, and 50 days of training restored thigh muscle and strength in a small study. It hasn't been tested in PMR.
PMRGCAuk's helpline finds that people who do often "feel pretty rough" the next day. Start at about half.
Source 23
Steroids raise the risk of a broken bone most in the first year, and repeated forced forward bending needs care on thin bones. Hinge from the hips instead.
The aim is comfortable range, strength and balance. The booklet says to stretch "as far as you comfortably can", and every move here can be done at a chair.
Source 17
With PMR, a new headache, a sore scalp, jaw pain when eating or any change in your sight can be giant cell arteritis: contact a GP or NHS 111 immediately.
Source 4
It can be a gentle way to stay moving, strong and steady alongside steroids, but no study has tested it in PMR. UK guidance recommends physical activity and pacing for everyone with PMR, and the PMR charity's booklet suggests trying Pilates.
No. Steroids relieve the inflammation, and you should never stop or change the dose yourself, because stopping suddenly can make you very unwell. Pilates helps with stiffness, strength and balance around them.
Seated moves first: Pilates breathing, gentle neck turns, shoulder rolls, elbow opening, seated twists, the table slide and the seated upper-back lift. Once symptoms are controlled, add sit to stand, standing leg lifts and balance at a chair, building from 5 to 20 over a month.
Moves that round your back under load or roll onto it, such as the roll-up, the hundred and curl-ups with your head up, rolling like a ball, the roll-over and the jack knife, because steroids thin the bones. Don't force a stiff shoulder, and stop neck turns that make you dizzy.
Yes, especially on stiff mornings. Our chair Pilates workout is all sitting or standing at the chair, with a hip hinge instead of rounding forward. Start with the seated half on bad days.
Later in the morning, once the stiffness has eased, or after a warm bath or shower. The NHS says the stiffness usually starts to improve after about 45 minutes as you become more active.
Start short: the booklet's stretches at least twice a day, and a class 2 or 3 times a week is a reasonable aim. Think of about half your earlier activity, and halve it again if you ache.
Strength work can: exercise improved muscle performance in people taking steroids for other conditions, and progressive resistance training is the first-line answer. Pilates on its own builds little strength in older adults, so add sit-to-stands and light weights.
Not on its own: Pilates hasn't been shown to build bone. Bone-protecting medicine now usually starts with the steroids, alongside walking and strength training, and Pilates helps with balance.
Doing too much can bring the aching and stiffness back for a day or so, especially if you go straight back to your old routine. If your symptoms come back as the dose comes down, contact your GP or rheumatology team.
No study has looked at it. With a teacher who knows about your steroids and bones, footwork lying down and light seated arm work can suit; skip the rolling and overhead series (our suggestion).
A new headache, a sore scalp, jaw pain when eating or talking, or any change in your sight: contact a GP or NHS 111 immediately. If you suddenly can't see from 1 or both eyes, call 999 or go to A&E.
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.
