Pilates for prostate cancer: during and after treatment, the pelvic floor and leaking, hormone therapy, tiredness and bones, and a class

A useful part of the week, not a treatment

Exercise hasn't been shown to slow prostate cancer or change PSA (prostate-specific antigen). The Pilates Method Alliance's own blog says "Movement cannot cure cancer."

Sources 1, 2, 3

The only Pilates trials are for leaking after surgery

In two small Brazilian trials, a weekly Pilates class did about as well as pelvic floor exercises with electrical stimulation, and better than no treatment, 4 months after prostate removal. Nothing else has been tested.

Sources 4, 5, 6

After surgery, the squeeze comes first

NICE (the National Institute for Health and Care Excellence) recommends supervised pelvic floor training for at least 3 months. No squeezes while the catheter is in. Most men start to improve 1 to 6 months after surgery.

Sources 7, 8, 9

On hormone therapy, strength and aerobic exercise first

NICE offers supervised strength and aerobic exercise at least twice a week for 12 weeks, which improves quality of life and walking. Pilates with a band or light weights can sit beside it.

Sources 10, 11, 12

Protect against falls, and bend safely

Fractures are more common on hormone therapy, and Pilates hasn't been shown to protect bone. Keep your head down in curl-ups, leave out rolling and loaded forward bending, and do balance work next to a counter.

Sources 13, 14, 15

Know the warning signs

A temperature during chemotherapy, new back or bone pain, signs of spinal cord compression and not being able to pee all need help straight away (below).

Sources 16, 17, 18

Treatment, in brief

The NHS: "Prostate cancer does not always need treatment." If it hasn't spread, your team may suggest monitoring it. Treatments include surgery to remove the prostate (a radical prostatectomy), radiotherapy and hormone therapy, and chemotherapy if the cancer has spread. "Hormone therapy alone does not cure prostate cancer, but it can slow it down and help symptoms."

Source 19

Leaking after surgery, and how long it lasts

You'll usually have a catheter for about 7 to 10 days, and most men can't fully control their bladder when it first comes out. Prostate Cancer UK: "Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover". In the trial figures NICE reproduces, 19 in 100 men offered surgery had moderate to severe leaking at 6 months and 13 in 100 at 6 years.

Sources 20, 9, 10

What hormone therapy changes

Hormone therapy (androgen deprivation therapy) can cause "a decrease in muscle tissue and an increase in body fat", bone loss that can start in the first year, hot flushes and low mood. NICE asks teams to tell men that tiredness "is a recognised side effect of this therapy, and might not be because of their prostate cancer". Tiredness is likely to be worse with more than one treatment at a time.

Sources 21, 10, 22

The heart and metabolism

Prostate Cancer UK says hormone therapy "might increase the chance of developing heart disease, stroke and type-2 diabetes". The research disagrees on how much: observational studies found more non-fatal heart and blood vessel disease, but in 8 randomised trials (4,141 men) hormone therapy wasn't linked with more heart deaths. It's a reason for checks and regular walking or other aerobic exercise, never a reason to stop treatment, which is your team's decision.

Sources 21, 23, 24

Men have a pelvic floor too

The pelvic floor muscles support your bladder and bowel and help control leaks. Prostate Cancer UK teaches the squeeze and says "Some types of exercise such as Pilates and yoga may also help to strengthen the pelvic floor muscles", though the page cites no study. Our Pilates for the prostate guide teaches the squeeze, the release and the knack.

Source 8

What a Pilates class asks

Mostly lying, side-lying, kneeling and seated work for the trunk, hips and spine. It's light activity (1.8 to 2.8 METs, multiples of the energy you use at rest). Many classic moves round the spine forward or twist it, which bone guidance asks you to change with thin bones or cancer in the bones. In 20 women, only the roll-ups, of 22 Pilates exercises, kept tummy pressure up longer than standing up from a chair; no study has measured men, but it's why long curls are the first moves to make smaller if you leak.

Sources 25, 15, 26

Two small Brazilian trials after prostate removalEmerging evidence

One team compared a weekly Pilates class (10 sessions), pelvic floor exercises with electrical stimulation, and no treatment, starting about 4 weeks after surgery. Pad-free at about 4 months: 57.7%, 50% and 22.6% (85 men); and continent: 59%, 54% and 26% (104 men). Stronger squeeze readings didn't predict who became dry.

Both trials are small, from one centre, with short follow-up, and their trial registrations list different numbers enrolled from the papers, so they may share participants. We could read only their summaries.

Sources 4, 5, 27

The Beijing studiesMixed evidence

One small trial of 42 men compared Pilates or Kegel squeezes with biofeedback against Kegels alone, but its summary doesn't say which group did Pilates. Other studies from the same hospital (37 to 48 men) had no group without Pilates, so they can't separate it from natural recovery. Their programme was daily 45-minute sessions for 2 months, lying, then sitting and standing, with pelvic floor squeezes.

Sources 28, 29, 30, 31

A 2025 network analysis: mixed, from the same two trialsMixed evidence

An analysis of 26 trials (2,650 men) is often quoted as concluding that "Pilates may be associated with worse outcomes". Its Pilates results rest only on the two Brazilian trials. Pilates was better than routine care for becoming dry, and worse only on the weight of pads used in 24 hours, a result that may be an artefact of the modelling on two small trials that may share participants.

Source 32

Reviews of Pilates in cancerMixed evidence

A 2025 review of Pilates in people with cancer, mostly breast cancer, reports benefits for quality of life and night-time peeing in prostate cancer, but its only prostate study is the first Brazilian trial, whose summary doesn't mention night-time peeing. We couldn't read either in full.

Sources 33, 4

Nothing else has been tested

Our searches found no Pilates trial in men on hormone therapy, for tiredness, bone, body composition or mood, during radiotherapy or chemotherapy, or with advanced prostate cancer.

Sources 6, 27

Exercise on hormone therapy helps quality of life and walkingStrong evidence

Across 18 trials (1,477 men on hormone therapy), supervised exercise improved disease-specific quality of life and walking, with moderate certainty, and injuries were rare. The newest network analysis (41 trials) ranked combined strength and aerobic training best for quality of life, and strength training best for muscle. In small trials, strength and aerobic exercise preserved or rebuilt muscle and limited fat gain.

Sources 10, 11, 34, 35, 36

Exercise doesn't change the cancerStrong evidence

Across 16 trials (1,574 men), there was "no evidence of benefit for disease progression, cardiovascular health, or sexual function", and no deaths from exercise. Combined training didn't change PSA.

Sources 1, 2

Living longer: not yet known

The one large trial testing whether exercise helps men with advanced prostate cancer live longer (INTERVAL-GAP4) closed early after recruiting 17% of its target, and its results hadn't been published when we searched in November 2026. Claims that exercise cuts prostate cancer deaths come from observational studies, which can't show cause.

Sources 37, 6

NICE recommends supervised pelvic floor trainingStrong evidence

"Offer supervised pelvic floor muscle training to men with stress urinary incontinence caused by prostatectomy. Advise them to continue the exercises for at least 3 months before considering other options." This is in NICE's guideline on urinary symptoms in men (CG97); the prostate cancer guideline (NG131) adds access to specialist continence services.

Sources 7, 10

How much the training adds is uncertainMixed evidence

Most men improve with time whatever they do. In a Cochrane review (50 trials, 4,717 men), training didn't clearly help men still leaking at 12 months (57% against 62% still leaking), and a 2023 Cochrane review calls the value of these treatments "uncertain", with most trials at high risk of bias. In the UK MAPS trial, four one-to-one sessions made no difference at a year (76% against 77%). A 2026 analysis of 7 trials favoured training at a year, with low certainty.

Sources 38, 39, 40, 41

Starting before surgeryEmerging evidence

Prostate Cancer UK suggests starting pelvic floor exercises "four to six weeks before the surgery". Across 12 trials (1,365 men), training before surgery helped continence at 3 months but not at 6 or 12, and a stricter 2026 review agreed.

Sources 8, 42, 43

The first weeks

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: "Avoid lifting heavy objects or doing manual work for eight weeks after surgery."

Sources 9, 8

When to add Pilates

Our suggestion: walk from early on, as your team advises, 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 the band and step work in our class until heavy lifting is allowed and they don't make you leak.

If you leak in class

Prostate Cancer UK: "Tighten the muscles strongly before and during activities that cause you to leak urine". Make the move smaller, squeeze before it, or swap a long curl for a head-down move such as the knee fold. Our Pilates for the prostate guide covers leaking in class in detail.

Source 8

NICE's offer: supervised strength and aerobic exerciseStrong evidence

"Offer people who are starting or having androgen deprivation therapy supervised resistance and aerobic exercise at least twice a week for 12 weeks to reduce fatigue and improve quality of life." International guidance suggests strength training at least twice a week, with at least 2 sets of 8 to 15 repetitions, alongside aerobic exercise. Our exercise for prostate cancer guide covers the doses.

Sources 10, 15, 44

Where Pilates fits

Prostate Cancer UK lists "body weight exercises, yoga or Pilates" among exercises that build muscle and strength, and says "Gentle resistance exercise, such as lifting light weights or using elastic resistance bands, is particularly good if you're on hormone therapy and are at risk of bone thinning." No trial has tested Pilates on hormone therapy. Our reading: Pilates with a band or light weights can be one of your strength sessions or sit beside the supervised programme, but a mat class with no added load is unlikely to match what the trials used.

Sources 12, 6, 15

Tiredness: exercise probably helps, mostly strength and aerobicMixed evidence

The strongest evidence is a 2024 Cochrane review of resistance training in people with many kinds of cancer, which found it probably eases tiredness during treatment. Reviews in prostate cancer itself disagree: one of 30 trials found combined training reduced tiredness, one of 20 found no clear effect, and a network analysis found benefit at very low certainty. Prostate Cancer UK: "Remember, any activity is better than none. Start doing what you can and build up slowly."

Sources 45, 2, 46, 47, 22

Hot flushes and mood

NICE: "Tell people that there is no good-quality evidence for the use of complementary therapies to treat troublesome hot flushes." No trial has tested Pilates for hot flushes or low mood on hormone therapy. Our suggestion: a cool room, layers and water. Our Pilates for stress and anxiety and Pilates for depression guides cover mood.

Sources 10, 6

During radiotherapyEmerging evidence

In 121 men starting radiotherapy, both strength and aerobic exercise eased tiredness in the short term, and strength training also helped quality of life over 24 weeks. Prostate Cancer UK says it's safe to do pelvic floor exercises "during and after your course of treatment". No Pilates trial exists during radiotherapy; gentle mat or chair Pilates on days you feel up to it is our suggestion.

Sources 48, 8

During chemotherapy

"If your white blood cell count is too low, you're at risk of getting infections, which can make you very unwell." Macmillan: "While your number of white blood cells is reduced, your cancer doctor might advise you to avoid busy public places." Our suggestion: use online or home classes then, and don't exercise with a temperature.

Sources 49, 50

What exercise can and can't do for boneMixed evidence

In a large US study of men over 65 who lived at least 5 years after diagnosis, 19.4% of those on hormone therapy had a fracture, against 12.6% of those not on it. In 154 men on hormone therapy, a year of impact and strength training slowed bone loss in the spine (about 1% against 2%), but a 2025 review of 18 trials found exercise didn't significantly increase bone density. Prostate Cancer UK: "We don't yet know whether exercise can help to prevent bone thinning in men who are on hormone therapy. But regular exercise may help to keep you strong and prevent falls that could lead to broken bones."

Sources 13, 51, 14, 21

Bend and twist safelyStrong evidence

International cancer exercise experts advise avoiding high-impact loads, hard bending or arching of the trunk, bending with added weight and fast twisting when bones are thin or the cancer has spread to them. Macmillan: "Some people with bone problems may also be advised to avoid exercises where you repetitively bend forward at the waist. This includes toe-touching and sit-ups." In Pilates, that means head-down curl-ups and no rolling, roll-ups, roll-overs or fast twists.

Sources 15, 50

With cancer in the bonesEmerging evidence

In 57 men with cancer in the bones, 3 months of supervised exercise planned to avoid loading the affected bones improved physical function and leg strength, with "no exercise-related adverse events or skeletal fractures". Experts advise starting "with active movement and no load or weight" and progressing slowly, with a professional experienced in cancer. Macmillan: "If you have secondary bone cancer in the spine or hip, check with your healthcare team whether this is safe for you to do."

Sources 52, 53, 50

Pilates with cancer in the spine, ribs or pelvis

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.

Sources 52, 15

Check first

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.

Source 12

In the first weeks after surgery

No squeezes while the catheter is in, no floor ab work until your team agrees, and no heavy lifting for 8 weeks. Then walking, and lying and seated moves with gentle squeezes.

Sources 9, 8

If you leak

Swap the roll-up, wall roll-up, teaser and long curl-ups such as the hundred for head-down moves such as the knee fold, and squeeze before you stand, bend or lift (our suggestion, as our Pilates for the prostate guide advises).

On hormone therapy or with thin bones

Use head-down versions of the hundred and single-leg stretch, and leave out rolling like a ball, the roll-over and the teaser, as their move pages advise with osteoporosis. Leave out the jack knife and deep rounding such as the spine stretch forward and the saw too (our suggestion, from the bone guidance above).

Sources 15, 50

Impact

Prostate Cancer UK: "If you're on hormone therapy or have cancer that has spread to the bones, check with your doctor before doing high-impact exercises such as running and contact sports." That includes jumping and the reformer's jump board.

Source 12

Hot flushes

Avoid hot Pilates, keep the room cool and have water to hand (our suggestion).

Call 999 (911 in the US)

Call 999, and don't drive yourself to A&E, for:

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.
• Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.
• Pain and swelling in one leg with breathlessness or chest pain, which can be a blood clot that has reached the lungs.

Sources 54, 55, 56, 57

During treatment: call 999 or your 24-hour number

Call 999 for chest pain that feels tight or squeezing or spreads to your arms, neck or jaw, severe difficulty breathing, or collapse. Call 999 too if difficulty breathing comes on suddenly, or you have pain in your chest or upper back: these can be signs of a blood clot in the lungs (a pulmonary embolism). Don't drive yourself to A&E (accident and emergency).

The NHS also says call 999 or go to A&E for possible sepsis, if someone is breathing very fast; is confused, has slurred speech or isn't making sense; has blue, pale or blotchy skin; has a very high or very low temperature, feels hot or cold to the touch, or is shivery; or has a rash that doesn't fade when you press it.

Sources 54, 57, 58

During treatment: use your 24-hour number

Use the 24-hour number you were given, or NHS 111 if you can't reach them, if during treatment you have:

• A temperature over 37.5°C or below 36°C, or you suddenly feel unwell even with a normal temperature.
• Signs of infection, such as feeling shivery, a sore throat, a cough, diarrhoea, or needing to pee a lot or pain when peeing.
• Throbbing or cramping pain, swelling and warmth in a leg or arm, or coughing up blood, which can be signs of a blood clot. Sudden breathlessness or chest pain means 999 (see above).

Source 18

Cancer in the bones: spinal cord compression

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:

• Back or neck pain that is new, severe or getting worse, worse when you move, cough or strain, or that disturbs your sleep.
• Problems controlling your bladder or bowel.
• Unsteadiness, difficulty walking, leg weakness or your legs giving way.
• Weak arms or hands, or trouble gripping.
• Numbness or pins and needles that is new or quickly getting worse.

Sources 16, 17

Don't wait

Our suggestion, in Prostate Cancer UK's words: "Don't wait to see if your symptoms get better and don't worry if you think it's an inconvenient time, such as the evening or weekend."

Source 16

On hormone therapy or with cancer in the bones

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.

Sources 12, 13

Stop exercising and speak to a doctor

Our suggestion, in Macmillan's words: stop exercising if you get any sudden symptoms, including feeling dizzy, chest pain, a racing heart, breathing problems, feeling sick, unusual back or bone pain, unusual muscle pain, or a headache that does not go away. "Speak to a doctor straight away if you notice any of these, or any other symptoms."

Source 50

Can't pee

Our suggestion, in Prostate Cancer UK's words: if you suddenly and painfully can't pee, "it needs treating straight away. If this happens, call your doctor or nurse, or go to your nearest accident and emergency (A&E) department." Tell them what treatment you've had.

Source 20

After prostate surgery

Contact your hospital team if:

• Your bladder feels full or the catheter isn't draining, or it leaks or falls out.
• Your urine has blood clots, turns cloudy, dark or red, or smells strong.
• The wound or the tip of your penis becomes red, swollen or painful.
• You have a fever (a temperature over 38°C).
• You feel sick or vomit, or get stomach cramps that won't go away.
• You get pain or swelling in the muscles of your lower legs.
• You can't open your bowels, even after a laxative.
• A painful lump appears at one of the keyhole wounds, especially if you're being sick.

Source 9

Blood in your pee

Our suggestion, in the NHS's words: "If you think you have blood in your pee, you need to get it checked, even if there's only a small amount or you're not sure it's blood." Ask for an urgent GP appointment or get help from NHS 111.

Prostate Cancer UK says blood in the urine can be "quite a common symptom of radiation cystitis" after radiotherapy, and to tell your doctor or nurse so they can check whether it's the treatment or an infection. The urgent line above still applies.

Sources 59, 20

Chest pain that comes and goes, or a racing heart: NHS 111

Get help from NHS 111: pain or tightness in your chest, neck, shoulders, jaw or arms that comes and goes, often brought on by exercise, stress, emotion or cold and easing after a few minutes' rest. It can be angina, a sign of a heart problem. If you've been diagnosed with angina, get help from NHS 111 too if it feels worse than before, is happening more often, lasts longer or happens when you're resting.

Get help from NHS 111: you're suddenly more short of breath than usual; you have chest pain and you feel sick or are being sick; or you have chest pain and you feel like your heart is racing, going too slowly, skipping a beat or fluttering.

Source 54

Unusual breathlessness

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.

Source 60

Stop the session if

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.

Source 61

Before you start

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

If you have a heart condition, follow your cardiac team's advice on how hard to work, and stop for the warning signs above. People with long-term conditions may wish to ask their specialist before starting. With uncontrolled high blood pressure, avoid straining against a held breath; the high blood pressure guide has more.

Source 61

"Pilates can cure prostate cancer or stop it spreading"Strong evidence

No trial shows exercise slows prostate cancer or changes PSA, and the trial designed to test survival closed early without results. The Pilates Method Alliance's own blog says movement can't cure cancer.

Sources 1, 2, 37, 3

"Pelvic floor exercises are only for women"Strong evidence

NICE recommends supervised pelvic floor training for men who leak after prostate removal, and Prostate Cancer UK teaches men the squeeze.

Sources 7, 8

"Pilates fixes leaking after prostate surgery"Mixed evidence

Two small trials found it about as good as pelvic floor exercises with stimulation at 4 months, and most men improve with time whatever they do. Pilates goes alongside the squeezes, not instead of them.

Sources 4, 5, 38

"A 2025 analysis showed Pilates makes leaking worse"Mixed evidence

The same analysis found Pilates better than routine care for becoming dry; the worse result was on pad weight, from the same two small trials, and may be a modelling artefact.

Source 32

"You shouldn't exercise during cancer treatment"Strong evidence

Macmillan: "Being active before, during and after cancer treatment is safe. But before starting any physical activity plan, it is important to talk to a healthcare professional first." Guidelines recommend aerobic and strength exercise during treatment, and NICE offers it on hormone therapy.

Sources 62, 44, 10

"Rest is best on hormone therapy"Strong evidence

Supervised exercise improved quality of life and walking in 18 trials, and Prostate Cancer UK says regular activity "can help to reduce fatigue".

Sources 11, 22

"Pilates will protect your bones on hormone therapy"Mixed evidence

No study has tested Pilates for bone in men, and even impact and strength training gave mixed results for bone density. What Pilates can help with is balance and leg strength, which lower the chance of a fall.

Sources 51, 14, 21

"With cancer in the bones, you can't exercise"Emerging evidence

In 57 men with cancer in the bones, a programme planned around the affected bones improved function with no fractures. Agree what you do with your team.

Sources 52, 53

"Pilates cools hot flushes"

No trial has tested it, and NICE says there's no good-quality evidence for complementary therapies for hot flushes.

Sources 6, 10