Pilates guide
Pilates can help men after prostate surgery, during prostate cancer treatment and with an enlarged prostate, as long as it carries a deliberate pelvic floor squeeze and sits beside the pelvic floor exercises the National Institute for Health and Care Excellence (NICE) recommends, never in place of them. In two small trials, a weekly Pilates class did about as well as pelvic floor exercises with electrical stimulation for becoming dry 4 months after prostate removal, but the evidence is thin and other studies are weaker.
Pilates doesn't replace prostate assessment, cancer treatment or your team's advice. This guide covers how men find and use the pelvic floor in Pilates, when to start after surgery (not while a catheter is in), which moves to change if you leak, protecting your bones on hormone therapy, Pilates with cancer in the bones, an enlarged prostate and pelvic pain, and when to get help fast. It ends with a free 20-minute men's pelvic floor class.
NICE recommends supervised pelvic floor muscle training for men who leak after prostate removal, for at least 3 months. Prostate Cancer UK suggests starting 4 to 6 weeks before surgery, not while a catheter is in, and says Pilates and yoga "may also help to strengthen the pelvic floor muscles".
Two small trials from one Brazilian group found a weekly Pilates class did about as well as pelvic floor exercises with electrical stimulation for becoming dry 4 months after surgery, and better than no treatment. Most other studies had no comparison group without Pilates, and a 2025 analysis ranked Pilates poorly.
Breathe out and squeeze as if stopping your pee and holding in wind: the base of your penis draws in and your testicles lift. Do the move, then relax fully. Pilates is a way to practise that squeeze lying, sitting and standing.
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NICE offers supervised strength and aerobic exercise at least twice a week for 12 weeks; do Pilates as well, not instead. Hormone therapy thins bones, so swap deep rounding, rolling and loaded twists for moves that keep your spine long.
But pelvic floor squeezes help dribbling after peeing and, alongside medicine, needing to go urgently, and you can build them into Pilates.
Suddenly not being able to pee, especially with pain low in your tummy, is an emergency. Blood in your pee, or pain with a fever, needs an urgent GP appointment or NHS 111. The full lists are below.
The NHS describes it as a small gland below the bladder that makes semen and controls the flow of pee to your penis. Prostate cancer treatments include surgery to remove the prostate (radical prostatectomy), radiotherapy and hormone therapy, which stops the body making testosterone or blocks it.
A sheet of muscle stretches from your pubic bone to your tailbone. Valves at the base of the bladder and under the prostate help stop leaks, and parts of the pelvic floor "wrap around these valves to assist them in staying closed", explains Pelvic, Obstetric and Gynaecological Physiotherapy (POGP), the UK's group of pelvic health physiotherapists. The same muscles relax to let you pee and help maintain an erection. Experts point out that men's continence works differently from women's, yet most trials in men used training designed for women.
Prostate surgery can affect the pelvic floor and its nerves. Prostate Cancer UK lists leaking when you cough, sneeze, stand up or bend forwards, needing to go urgently, and leaking more towards the end of the day as the muscles tire. Most men's leaking improves over the months after surgery, whatever they do.
Pilates breathing and its focus on the deep tummy muscles can carry a deliberate pelvic floor squeeze into each move, as UK pelvic health physiotherapists teach women in their Pilates booklet. POGP's booklet for men asks you to lift on the breath out and to "fully relax after each long or short contraction". No guideline recommends Pilates in place of pelvic floor exercises for men.
From POGP's pelvic floor booklet for men and Prostate Cancer UK. Not while a catheter is in.
See the movement on the 3D figure: Pelvic floor exercise (Kegel)
Prostate Cancer UK suggests starting pelvic floor exercises 4 to 6 weeks before surgery. Across 12 studies (1,365 men), training before surgery helped continence at 3 months, but not at 6 or 12.
"Do not do pelvic floor muscle exercises while you have a catheter in", Prostate Cancer UK says. Start as soon as it's out.
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Avoid heavy exercise for the first 4 to 6 weeks; short walks are fine if your surgeon suggests them. Start pelvic floor exercises only once the catheter is out, and ask your surgical team before floor-based ab work. If you're having hormone therapy or the cancer has spread to your bones, avoid activities where you could fall.
Prostate Cancer UK also advises no heavy lifting or manual work for 8 weeks after surgery.
Our suggestion: walk from early on, as your team suggests, then add gentle lying and seated Pilates with the squeeze built in once your surgical team agrees floor work is fine. Leave curl-ups, roll-ups and harder work until your team clears them and they don't make you leak.
Daily pelvic floor exercises as POGP sets out, building towards up to 10 long squeezes held for up to 10 seconds and up to 10 short ones, at least 3 times a day. Add our 20-minute men's pelvic floor class 2 or 3 times a week (our editorial starting point; the trials ran Pilates from a weekly class with daily home exercises to daily sessions). POGP expects improvement in 3 to 6 months.
Tighten your pelvic floor before and during coughing, sneezing, lifting or getting up from a chair. In class, squeeze just before you stand up or bend forwards (our suggestion).
Bending forwards and moves that hold tummy pressure up for a while, such as roll-ups, are the likeliest to bring on a leak: make the move smaller, squeeze before it, or swap it for a head-down move such as the knee fold (our suggestion). In a study of 20 women, roll-ups kept tummy pressure up longest of 22 Pilates exercises.
Erection problems are common after prostate surgery. Pelvic floor training for erections after surgery has mixed results (4 of 12 trials found a benefit); our Pilates for erectile dysfunction guide covers it.
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Pelvic floor exercises and NICE's guidance carry the evidence after surgery, and supervised strength and aerobic exercise on hormone therapy. Pilates rests on a handful of small studies, all about leaking after surgery.
"Offer supervised pelvic floor muscle training to men with stress urinary incontinence caused by prostatectomy", NICE says, and to keep going for at least 3 months before considering other options.
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Most men's leaking improves over the first year whatever they do. In a Cochrane review (50 trials, 4,717 men), 57% of men who trained were still leaking at a year against 62% of those who didn't, a difference that could be chance. In the UK MAPS (Men After Prostate Surgery) trial, four one-to-one sessions made no difference at a year (76% against 77% still leaking). A 2026 analysis of 7 trials favoured training at a year, with low certainty.
One group compared a weekly, physiotherapist-led Pilates class for 10 weeks, with daily home exercises, against pelvic floor exercises with electrical stimulation and against no treatment. Pad-free at 4 months: 57.7% with Pilates, 50% with exercises and stimulation and 22.6% with no treatment (85 men); and 59%, 54% and 26% (104 men). Pelvic floor strength didn't predict who became dry.
We could read only the summaries of these papers, and the trial registrations don't match them: the first lists 54 men enrolled, against 85 who finished in the paper; the second lists 115, against 123 randomised.
Four studies from one hospital (37 to 48 men each) reported improvements in leaking, or in pelvic floor muscle activity, over 8 weeks of Pilates with pelvic floor training. Three had no group that didn't do Pilates, and the summary of the one randomised trial doesn't make clear which result belongs to the Pilates group, so they can't show that Pilates added anything.
A network analysis of 13 treatment approaches ranked electrical stimulation with biofeedback highest and concluded that "Pilates may be associated with worse outcomes". We could read only its summary, so it's unclear which trials that rests on, and its studies differed a lot.
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Our searches found no Pilates trial in men on hormone therapy, with an enlarged prostate or with chronic prostatitis. A registered Egyptian trial of Pilates with shockwave therapy after surgery has posted no results.
NICE offers people starting or having hormone therapy supervised resistance and aerobic exercise at least twice a week for 12 weeks "to reduce fatigue and improve quality of life". Across 18 trials (1,477 men), supervised exercise improved quality of life and walking; across 16 trials, exercise improved fatigue, fitness and leg strength, with no evidence that it slows the cancer.
Across 8 trials (594 men), exercise didn't change PSA or testosterone levels.
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Pilates counts as muscle-strengthening, but NICE's offer is supervised strength and aerobic exercise. Prostate Cancer UK says "Gentle resistance exercise, such as lifting light weights or using elastic resistance bands, is particularly good if you're on hormone therapy". Our suggestion: Pilates twice a week alongside that programme, not instead.
Hormone therapy "can make you feel extremely tired", Prostate Cancer UK says. On tired days, do the lying and seated parts only (our suggestion).
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In a large US study, 19.4% of men on hormone therapy had a fracture within 5 years, against 12.6% of men not on it. In two trials, strength and impact exercise slowed bone loss in the spine, though Prostate Cancer UK says it isn't yet known whether exercise prevents bone thinning.
International cancer exercise experts advise avoiding hard bending or arching of the trunk, bending with added weight, and fast twisting when bones are thin, and making falls prevention a goal. The UK osteoporosis consensus suggests alternatives to the Pilates roll-down and curl-up. So use head-down versions, keep your spine long, and leave out rolling like a ball and the roll-over (our reading).
Prostate Cancer UK says to avoid activities where you could fall if you're on hormone therapy or the cancer has spread to your bones. Do balance work next to a counter (our suggestion); from 65, the NHS asks for strength, balance and flexibility work on at least 2 days a week.
Speak to your GP, nurse or hospital doctor before you start, especially if you have joint or muscle problems. Check with your doctor before high-impact exercise such as running, or contact sport, if you're on hormone therapy or the cancer has spread to your bones.
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In 57 men with cancer in the bones, 3 months of supervised exercise planned around the affected bones improved physical function and leg strength, with no fractures from the exercise. Ask your cancer team before mat Pilates.
Our reading of this guidance: with cancer in the spine, ribs or pelvis, leave out curl-ups (the hundred and leg stretches with the head up), roll-ups and roll-downs, rolling moves, legs-overhead moves, twists such as the saw and spine twist, and deep side bends. Keep a neutral spine with leg, arm and breathing work, and check each new move with your team.
An enlarged prostate is "very common in men over the age of about 50", Prostate Cancer UK says, and not everyone with one has symptoms. It isn't caused by prostate cancer and doesn't raise your risk of it. Symptoms include difficulty starting to pee, a weak flow, dribbling after you finish, and needing to go more often or urgently, including at night.
It won't shrink the prostate. Active men tend to have fewer urinary symptoms (11 observational studies), but in 6 small trials it was "uncertain whether physical activity affects symptom scores". No study has tested Pilates.
Squeeze your pelvic floor strongly straight after peeing to empty the last drops, or press gently with your fingertips behind your scrotum and move them forwards and upwards. In a trial of 49 men, pelvic floor exercises cut dribbling more than the press. Added to medicine, pelvic floor training with ways to hold on cut toilet trips by about 2 a day against 1 in 158 men (an unblinded trial).
In 1,077 men in general practice, a nurse-supported self-help booklet lowered symptom scores a little at a year. The NHS lists lifestyle changes, pelvic floor training and bladder training among the first treatments.
Alpha blockers such as tamsulosin can cause dizziness, particularly when you sit down or stand up, and low blood pressure and fainting, especially when you first start them. The NHS says that if tamsulosin makes you dizzy, don't drive, ride a bike or use machinery until it passes, and call NHS 111 if you faint. Get up slowly after floor exercises.
For 48 hours before a PSA test, the NHS asks you not to "do anything that leaves you out of breath, such as exercise", or ride a bike. Our reading: keep any Pilates in those 2 days very light, or skip it.
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With chronic prostatitis or pelvic pain, the pelvic floor may be too tight rather than weak. POGP treats tight muscles by helping them relax, and Prostate Cancer UK says "Some men find that doing regular gentle stretching exercises can help them feel better and reduce symptoms". Use the relaxation and breathing moves and gentle stretches, leave out extra squeezes, and see a GP or pelvic health physiotherapist (our suggestion).
Pain in your penis, scrotum, testicles or bottom, pain when peeing or ejaculating, or a high temperature need a GP. If you can't pee at all, use the urgent lists below.
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Pelvic floor exercise: "Start with 8 slow holds of up to 10 seconds and 8 quick squeezes, three times a day, and build towards 10 of each" (from the move page's dose). Pelvic floor relaxation: "5 to 10 slow breaths, 1 to 3 times a day" (from the move page's dose). Lateral breathing: "5 to 8 breaths at the start of every session" (from the move page's dose). Then squeeze as you breathe out and move: heel slide, "10 slow repetitions each side"; knee fold, "2 sets of 5 to 10 each side"; bent-knee fall-out, "2 sets of 5 to 10 each side" (each from the move page's dose); pelvic tilt into bridge, 6 to 8 slow, squeezing on the way up (our editorial starting point; with thin bones, peel up only part of the way).
3D demoPelvic floor exercise (Kegel)Beginner · No equipment
3D demoPelvic floor relaxation (reverse Kegel)Beginner · No equipment
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoBent-knee fall-outBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipmentLeaks often happen as you stand up, so the squeeze moves with you. Clamshell: 8 each side, squeezing as the knee opens; bird dog, one limb: 5 each arm and leg (both our editorial starting points). Seated march: "1 to 2 minutes as a warm-up" (from the move page's dose); seated knee extension: 8 each leg, squeezing as you straighten (adapted from the move page's dose). Sit to stand: 8 slow, squeezing just before you stand (our editorial starting point). Thoracic rotation: "6 rotations per side, moving with the breath" (the move page's dose). Overhead side bend: "3 slow bends per side, exhale into each" (the move page's dose), left out with cancer in the spine, ribs or pelvis. Wall side leg lift: "10 to 12 each side" (from the move page's dose).
3D demoClamshellBeginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoSeated marchBeginner · A bench or box
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoSit to stand from a chairBeginner · A bench or box
3D demoThoracic rotationBeginner · No equipment
3D demoOverhead side bendBeginner · No equipment
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wallBand row: "3 sets of 10 to 15" (from the move page's dose). Single-leg stand and tandem stance: next to a counter, 3 holds of 20 to 30 seconds each leg, at least twice a week (our editorial starting point). Heel drop: "20 to 30 drops at first, building toward about 50 impacts on most days" (from the move page's dose), only without cancer in the bones and with your doctor's agreement.
No squeezes while the catheter is in. Then walking, and lying and seated moves with gentle squeezes once your team says floor work is fine.
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Swap the roll-up, wall roll-up, teaser and long curl-ups such as the hundred and double-leg stretch for head-down moves such as the knee fold. The roll-up, wall roll-up and teaser pages already suggest this with leaking; for the hundred and double-leg stretch, it's our suggestion.
Use head-down versions of curl-ups, and leave out rolling like a ball, the roll-over, the jack knife and deep forward rounding such as the spine stretch forward and the saw, as their osteoporosis cautions advise (our reading for hormone therapy).
Our reading of this guidance: with cancer in the spine, ribs or pelvis, leave out curl-ups (the hundred and leg stretches with the head up), roll-ups and roll-downs, rolling moves, legs-overhead moves, twists such as the saw and spine twist, and deep side bends. Keep a neutral spine with leg, arm and breathing work, and check each new move with your team.
Relaxation, breathing and gentle stretches only; no extra squeezes.
Get up slowly from the mat, as the warning signs below set out.
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Our men's pelvic floor class teaches the squeeze and the release lying down, then carries the squeeze into side-lying, seated and standing moves. No trial has tested it: its order and doses are our editorial choice, from POGP's men's booklet and the lying, chair and standing order of the Chinese programme. Keep up your separate daily squeezes too. Use the cancer class during treatment or with cancer in the bones (with your team's agreement), and the osteoporosis class if your bones have thinned on hormone therapy. With pelvic pain, use the relaxation routine instead.
A 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 movesA bench or box, Something with weightA 5-minute daily pelvic floor workout for women and men: slow holds and quick squeezes, three times a day, with how to find the right muscles.
5 minBeginner2 movesNo equipmentAn 8-minute routine for a tight pelvic floor: slow breathing and comfortable positions to help the muscles let go, with no strengthening squeezes.
8 minBeginner5 movesFirm cushionA gentle 25-minute Pilates class for during and after cancer treatment: breathing, shoulders, legs and balance, with no curls, twists, planks or rolling.
25 minBeginner17 movesA bench or box, A bandA 25-minute Pilates workout for osteoporosis and osteopenia: the Royal Osteoporosis Society's swaps for rounding moves, plus back strength and balance.
25 minBeginner16 movesA wall, A 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 movesA wallFor strength and walking alongside a supervised programme on hormone therapy, with your team's agreement.
A 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 minBeginner6 days a weekA free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginnerThe lists are from our exercise guides for an enlarged prostate and prostate cancer and our Pilates for cancer guide, word for word; the chest pain, stop and before-you-start lines are the ones our other Pilates guides use. 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.
Don't drive yourself to A&E. Call 999 or go to A&E now if:
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Contact your hospital team if:
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Call 999, and don't drive yourself to A&E, for:
Don't exercise if you feel unwell or have pain, sickness or other unusual symptoms, and stop if they start while you're exercising. Have new or worsening bone pain checked by your team before you carry on, and after a fall with pain or a new limp, get checked, as fractures are more likely on hormone therapy (our suggestion). Our cancer guide's warning signs list the signs of spinal cord compression, which needs help straight away.
Spinal cord compression is when cancer presses on the spinal cord. Contact your hospital team straight away, even at the weekend, and go to A&E if you can't reach anyone, if you have any of these:
Alpha blockers such as tamsulosin can cause dizziness, particularly when you sit down or stand up, and low blood pressure and fainting, especially when you first start them. The NHS says that if tamsulosin makes you dizzy, don't drive, ride a bike or use machinery until it passes, and call NHS 111 if you faint. Get up slowly after floor exercises.
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If you feel dizzy, stop and sit down. If you can't pee after a long ride or session, treat it as retention and use the lists above (our suggestion).
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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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 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.
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No study shows exercise shrinks the prostate, and no Pilates study exists in an enlarged prostate. Pelvic floor squeezes help symptoms such as dribbling and urgency, not the gland.
Two small trials from one group found it matched exercises with electrical stimulation at 4 months, but a network analysis ranked Pilates poorly and NICE recommends supervised pelvic floor training. Use Pilates with the squeeze built in, as an extra.
NICE recommends supervised pelvic floor training for men who leak after prostate surgery, and POGP publishes a booklet for men.
Core strength isn't the same as a pelvic floor squeeze. Men's continence depends on the muscles around the outlet of the bladder, so the squeeze needs practising on purpose; in women, Pilates without deliberate squeezes didn't strengthen the pelvic floor, as our Pilates for the pelvic floor guide explains.
Across 8 trials, exercise didn't change PSA or testosterone. Skip exercise and cycling for 48 hours before a PSA test only so the reading is accurate.
NICE offers supervised strength and aerobic exercise at least twice a week for 12 weeks. Pilates fits alongside it.
Prostate Cancer UK says try it once or twice to find the right muscles, but don't do it regularly, as it could cause problems emptying your bladder.
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No trial shows exercise slows prostate cancer; a global trial set up to test survival closed early. The benefits are for tiredness, fitness and quality of life.
It can help alongside the pelvic floor exercises NICE recommends, not instead of them. In two small Brazilian trials, a weekly Pilates class did about as well as pelvic floor exercises with electrical stimulation for becoming dry at 4 months, but a 2025 analysis ranked Pilates poorly, so the evidence is thin.
Start the pelvic floor squeezes once the catheter is out, walk from early on, and ask your surgical team before floor exercise. Avoid heavy exercise for the first 4 to 6 weeks and heavy lifting for 8 weeks, as Prostate Cancer UK advises. Our suggestion is gentle lying and seated Pilates first.
Breathe out and squeeze as if stopping your pee and holding in wind, so the base of your penis draws in and your testicles lift; do the move; then relax fully. Squeeze just before you stand up, cough or bend.
Leave roll-ups, the teaser and long curl-ups until your team agrees and they don't make you leak; head-down moves such as knee folds and heel slides are gentler (our suggestion). Moves that bend you forwards are the likeliest to bring on a leak.
It's safe for most men and counts as muscle-strengthening, but no Pilates trial has tested it in prostate cancer beyond leaking after surgery. On hormone therapy, NICE offers supervised strength and aerobic exercise, so do Pilates as well, not instead.
Yes, with changes: hormone therapy thins bones, so swap deep rounding, rolling and loaded twists for moves that keep your spine long, and do balance work near support. In one large study, 19.4% of men on hormone therapy had a fracture within 5 years, against 12.6% of men not on it.
Ask your cancer team first; in a trial of 57 men, supervised exercise planned around the affected bones was safe. Leave out curl-ups, roll-ups, rolling, legs-overhead moves, twists and deep side bends, and check each new move with your team.
It won't shrink the prostate. Pelvic floor squeezes help dribbling after peeing and, alongside medicine, needing to go urgently, and you can build them into Pilates. If you take tamsulosin, get up slowly from the mat.
Squeeze your pelvic floor strongly straight after peeing, or press gently with your fingertips behind your scrotum and move them forwards and upwards. In one trial, pelvic floor exercises worked better than the press.
Gentle stretching helps some men, Prostate Cancer UK says, but more squeezing may not, because tight muscles need to relax. Use the relaxation and breathing moves and see a GP or pelvic health physiotherapist.
For 48 hours before, the NHS asks you not to do anything that leaves you out of breath or ride a bike. Our reading is to keep any Pilates in those 2 days very light, or skip it.
Call 999 if you suddenly can't pee, especially with pain low in your tummy. Get an urgent GP appointment or call NHS 111 for blood in your pee, pain when peeing, or a fever with back or side pain. After surgery, contact your hospital team if the catheter stops draining or the wound gets red and swollen.
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.
