Pilates for PTSD and trauma: movement and the body, choice and safety in a class, breathing, sleep and mood, the evidence, and a class

Get help straight away

The NHS says a mental health emergency should be taken as seriously as a physical one, and that you will not be wasting anyone's time.

• Call 999 or go to A&E if your life is at risk: for example, you have seriously harmed yourself or taken an overdose, or you feel you can't keep yourself safe.
• For urgent help in England, call 111 and select the mental health option, or use 111 online.
• Call Samaritans on 116 123. It is free, any time, day or night.
• In the US, call or text 988, the 988 Suicide and Crisis Lifeline, any time.

Sources 1, 2, 3, 4

Specialist support

Our exercise for PTSD and Pilates for veterans guides list more services.

• If you've been affected by rape, sexual assault or abuse and you're 16 or over in England or Wales: the Rape Crisis 24/7 Support Line, 0808 500 2222, free, or online chat. It isn't an emergency service: if you're in immediate danger, call 999.
• Veterans, reservists and people leaving the forces in England: Op COURAGE, the NHS mental health service for veterans. You can contact it yourself, or ask a GP or a charity to refer you.

Sources 5, 6

Therapy is the treatment; Pilates is an addition

The National Institute for Health and Care Excellence (NICE) recommends trauma-focused talking therapies. NICE and the US Department of Veterans Affairs and Department of Defense (VA/DoD) make no recommendation for or against exercise: the VA/DoD found "insufficient evidence to recommend for or against" aerobic or non-aerobic exercise.

Sources 7, 8, 9

No Pilates trial has measured PTSD symptoms

The only Pilates study in people with PTSD is a one-page conference poster, which measured balance and coordination, not PTSD. A small study in a women's refuge measured coping, not PTSD, and had no comparison group.

Sources 10, 11, 12

Exercise helps a little, alongside treatment

Across 15 trials, exercise and movement eased PTSD symptoms by a moderate amount on average, but results varied widely and no type was clearly best. Two larger trials found no added benefit when physical activity was added to treatment.

Sources 13, 14, 15

Mood and sleep may improve, though not tested in PTSD

In people without PTSD, mostly women, Pilates lowered depression and anxiety scores in 18 small trials and improved sleep quality scores in 6, with wide variation. It hasn't been tested in PTSD.

Sources 16, 17

A class built on choice, with no surprise touch

Trauma-informed practice rests on 6 principles: "safety, trust, choice, collaboration, empowerment and cultural consideration". Every move optional, eyes open, a predictable order, and cues in words: you can say no to any hands-on correction, every time.

Sources 18, 19

Slow breathing helps many people; holds are your choice

Slow breathing is the NHS's calming technique. Breath holds brought anxiety or a feeling of constriction to some people with PTSD in one trial, and Pilates breathing doesn't need them.

Sources 20, 21

PTSD, in plain words

"PTSD (post-traumatic stress disorder) is a mental health condition caused by very stressful, frightening or distressing events. Medicines and therapy can help manage it." (the NHS) The main symptom is distressing thoughts about the event: "You may experience this as flashbacks, vivid or intrusive images or thoughts, and recurring dreams or nightmares." Our exercise for PTSD guide covers causes, numbers and the body's alarm.

Source 22

Complex PTSD

NICE describes complex PTSD as following events "from which escape is difficult or impossible (for example, torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse)".

Source 7

Treatment

NICE recommends individual trauma-focused cognitive behavioural therapy (CBT), which includes "strategies for managing arousal and flashbacks", and eye movement desensitisation and reprocessing (EMDR) for some adults. Adults can refer themselves to NHS talking therapies.

Sources 7, 22

What a Pilates class asks

Hands-on correction, lying on your back with your knees falling open or face down, resting with your eyes closed, focusing on your breath, being strapped into reformer foot straps, a teacher walking behind you, mirrors and closed doors. Any of these can be a reminder of trauma for some people, so each is optional in a trauma-informed class (our list).

Sources 18, 23

Trauma-informed practice

The UK government's working definition says: "The purpose of trauma-informed practice is not to treat trauma-related difficulties". Trauma-informed physical activity providers stress "boundaries and scope of practice" and referring people on. In a review of 11 studies of people's experiences of yoga after trauma, "The main facilitator was the feeling of safety generated in the trauma-informed yoga classes." A Pilates class can aim for the same (our reading).

Sources 18, 24, 25

No Pilates trial has measured PTSD symptomsStrong evidence

Our searches on 2 November 2026 found no Pilates trial of PTSD symptoms. A 2021 conference poster, a one-page abstract, measured balance and coordination, not PTSD, in army staff with PTSD. In a women's refuge, 15 of 22 women finished 8 weeks of Pilates, with better scores on coping and patterns of thinking, but no comparison group and no PTSD measure. One case report describes Pilates-based exercise alongside therapy over 10 years.

Sources 10, 11, 12, 26

What the guidelines sayStrong evidence

NICE found "only small single studies" of exercise, not enough for a recommendation, and judged yoga's evidence weak, noting that 46% dropped out of yoga against 15% of comparison groups. The VA/DoD found "insufficient evidence to recommend for or against" exercise or yoga. The American Psychological Association (APA) names trauma-sensitive yoga among "potentially promising" studies, without a recommendation.

Sources 8, 9, 27

Exercise added to treatmentMixed evidence

A 2026 review of 15 trials (863 people) found exercise and movement eased PTSD by a moderate amount on average (Hedges' g of -0.49), but the range of results a new trial might give crossed zero, and no type was clearly better than an active comparison. Two other reviews found similar average effects (14 and 16 trials). Certainty is low.

Sources 13, 28, 29

Two larger trials found no added benefitEmerging evidence

In 338 refugees, adding body awareness therapy or mixed physical activity to treatment changed nothing; in 119 adults having 8 days of intensive treatment, 80% and 83% no longer met PTSD criteria with or without physical activity.

Sources 14, 15

Trials of strength training and walking, and of exercise after therapyEmerging evidence

In 81 inpatients, strength training and walking added to care lowered PTSD symptoms by 5.4 points and improved sleep. In 130 adults, 10 minutes of aerobic exercise after each exposure therapy session lowered PTSD scores more at 6 months than 10 minutes of passive stretching, the comparison.

Sources 30, 31

Yoga, the nearest practice to PilatesMixed evidence

Across 20 trials, yoga improved PTSD that people rated themselves, but "using clinician-reported assessments, yoga interventions were not associated with improved PTSD symptoms". In 131 women veterans, trauma-sensitive yoga did about as well as group therapy over 3 months, and more people finished it; in 64 women, 52% no longer met PTSD criteria after yoga against 21% with health education. Gains faded by 7 months in one trial, and the trials carry a substantial risk of bias.

Sources 32, 33, 34, 35, 36, 37

Mind-body exerciseMixed evidence

Across 16 trials of mind-body exercise, PTSD symptoms fell by a small to moderate amount; none of the trials was of Pilates.

Source 38

Pilates, mood and sleep in generalEmerging evidence

In 18 trials (827 women), Pilates lowered depression and anxiety scores by moderate amounts, mostly against no exercise; an earlier review warned of small trials of variable quality. The largest review (32 trials) found clear gains in quality of life and self-esteem but limited effects on depression and anxiety. Across 6 trials, Pilates improved sleep quality scores, with very wide variation. In 23 stressed adults, Pilates and yoga helped about equally. None of these was in people with PTSD.

Sources 16, 39, 40, 17, 41

Preventing PTSD after a traumaMixed evidence

Mind-body exercise soon after a trauma didn't clearly prevent PTSD in 6 studies with 399 people.

Source 42

You're in control

You decide what to do, how far to go and when to stop. A trauma-informed teacher offers choices ("if you like", "you might") rather than instructions, keeps the same order each week, and says what's coming next.

Source 18

Touch and consent

Pilates teachers often correct position by touch. The Pilates Method Alliance's code of ethics counts inappropriate physical contact as improper behaviour, though it doesn't set out a consent rule for hands-on cues. Ask your teacher to cue with words only, and say no to any touch, every time (our suggestion).

Source 19

The room

Choose a spot with your back to a wall and a view of the door, a quiet time, or a one-to-one or home session if a group feels too much. Women veterans in one study preferred home-based, group-supervised, moderate exercise.

Source 43

Noticing your body is optional

Pilates asks you to notice your body, but in a trial of 33 people, prompting them to focus on body sensations during exercise reduced the improvement in feeling on edge. Notice what feels useful and let the rest go.

Source 23

Teachers know their limits

A Pilates class isn't therapy. Ask a teacher whether they've trained in trauma-informed teaching, how they use touch, and whether you can watch first or start one to one.

Sources 24, 18

If a flashback or panic starts

Stop, sit with your feet on the floor, look around and name where you are, and breathe slowly. Tell your therapist, so you can plan for it: trauma-focused therapy includes ways of managing arousal and flashbacks.

Source 7

Slow, gentle breathingStrong evidence

The NHS's calming breath is counting in and out "from 1 to 5", unforced, and its PTSD self-help includes "try breathing exercises". Pilates lateral breathing is slow and fits that.

Sources 20, 22

Breath holds: your choiceEmerging evidence

In a trial of 74 people having trauma-focused CBT, yoga breathing with breath holds led some to report repeated anxiety or a feeling of constriction, and one stopped after a "flashback of suffocation". Across 6 trials, yogic breathing helped symptoms a little against no treatment. Pilates breathing has no holds; skip holds if they don't suit you.

Sources 21, 44

If focusing on your breath feels worse

Breathe normally, open your eyes and notice your feet on the floor or the room around you instead, and tell your therapist (our suggestion). If a breathing exercise brings on panic, dizziness or a feeling of being smothered, stop it and breathe normally.

Sources 21, 7

SleepEmerging evidence

In one PTSD trial, strength training and walking improved sleep. In people without PTSD, Pilates improved sleep quality scores across 6 trials, with wide variation. The NHS's PTSD self-help includes "try to get enough sleep" and "stay active".

Sources 30, 17, 22

MoodEmerging evidence

Pilates lowered depression and anxiety scores in small trials in women, though the largest review found clearer gains for quality of life and self-esteem. Our Pilates for depression and Pilates for stress and anxiety guides have more.

Sources 16, 40

Lying face down

The swan, swimming and single and double leg kicks: optional; the seated upper-back lift works the same muscles sitting up.

Source 18

A long rest with your eyes closed

Keep it short and optional, or sit up with your eyes open. Across 83 meditation studies, side effects such as anxiety or low mood were reported by 8.3% of people.

Sources 18, 45

Positions that can feel exposed or trapped

Lying with your knees falling open, child's pose, or your feet in reformer straps: optional. Use side-lying, seated or standing versions instead.

Source 18

Breath holds

Box breathing and 4-7-8 breathing hold the breath: your choice, and skip them if they bring on dizziness or panic.

Source 21

Call 999 (911 in the US) or go to A&E now

Call 999 or go to A&E if:

• Your life is at risk: for example, you have seriously harmed yourself or taken an overdose.
• You feel you may be about to harm yourself, or you can't keep yourself or someone else safe.
• During exercise, you have chest pain that feels tight or like squeezing, or spreads to your arms, neck or jaw, or severe difficulty breathing, or someone passes out and isn't responding normally.

Sources 1, 2, 46

Get urgent help today

• In England, call 111 and select the mental health option, use 111 online, or ask for an urgent GP appointment.
• Call Samaritans free on 116 123, any time, day or night (UK and Ireland). If you're under 19, you can also call Childline on 0800 1111.
• Text SHOUT to 85258, any time.
• Contact your mental health crisis team if you have one.
• In the US, call or text 988, the 988 Suicide and Crisis Lifeline, any time.
• After rape, sexual assault or abuse (England and Wales, aged 16 or over): the Rape Crisis 24/7 Support Line, 0808 500 2222.

Sources 1, 2, 3, 4, 5

See a GP soon

If you're 18 or over (or 16 or over in some areas), you can also refer yourself to NHS talking therapies without seeing a GP.

• You think you have symptoms of PTSD, or you've been diagnosed and treatments are not helping (or speak to your mental health specialist if you have one).
• Symptoms are troubling you after a recent trauma: you don't need to wait a month, because NICE recommends trauma-focused CBT even in the first month for clinically important symptoms.

Sources 22, 7

Veterans and service leavers

In England, Op COURAGE is the NHS mental health service for people leaving the forces, reservists, veterans and their families. You can contact it yourself or through a GP or a charity, however long ago you left.

Source 6

During a class

If a flashback, panic or feeling cut off from your surroundings starts, stop and use the grounding steps above, then tell your therapist. If a class keeps making symptoms worse, change the setting or the type of exercise rather than pushing through (our suggestion).

Sources 7, 21

Medicines

The NHS says don't stop taking PTSD medicine unless you're told to by a doctor, even if you feel better.

Source 22

Chest pain or collapse

Call 999 if:

• 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.

Sources 47, 46, 48

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 49

"Pilates treats PTSD"Strong evidence

No trial has tested Pilates on PTSD symptoms, NICE and the VA/DoD make no recommendation for or against exercise, and in two larger trials adding physical activity to treatment made no difference. Trauma-focused therapy and, if you choose, medicines are the treatments.

Sources 10, 8, 9, 14, 15

"Trauma is stored in your core, and Pilates releases it"Mixed evidence

This isn't established, and no study tests it. A 2026 commentary found the claim that body-based treatments are uniquely effective lacks support; studies of trauma releasing exercises "were not consistently rigorous"; somatic experiencing has preliminary evidence of mixed quality. Strong feelings in a class are common, and they're a reason for trauma-sensitive teaching, not proof of stored trauma. Our somatic Pilates guide looks at the idea.

Sources 50, 51, 52

"Any gentle class is trauma-informed"Emerging evidence

Trauma-informed practice rests on 6 principles, and a gentle class can still include hands-on correction, long eyes-closed rest and face-down moves.

Source 18

"If feelings come up, push through to release them"Emerging evidence

Stop, ground yourself and tell your therapist. Breath holds brought anxiety and one flashback in a trial, and side effects such as anxiety are reported in meditation studies.

Sources 21, 45, 7

"Focusing on your body is always the point"Emerging evidence

In one trial, prompting people to focus on body sensations during exercise reduced the benefit for feeling on edge. Noticing your body should be an option.

Source 23

"Exercise works for everyone with PTSD"Mixed evidence

The average benefit is modest and results vary widely, and some trials found none. If Pilates doesn't suit you, another kind of exercise might.

Sources 13, 14