No study has tested Pilates for restless legs
Our searches found no published study. The only Pilates study is registered, in older adults on dialysis, and hasn't reported any results.
Pilates guide
Pilates for restless legs: evening stretches, timing, iron and what the evidence shows
Restless legs syndrome (RLS) is a strong urge to move your legs, usually with uncomfortable feelings, that comes on when you rest in the evening or at night and eases when you move. Pilates can fit well: gentle leg stretches and slow leg circles in the early evening follow the NHS's advice to walk, stretch or massage your legs, and leg strength work earlier in the day follows the one exercise trial. But no study has tested Pilates for restless legs, and the treatments with the most evidence are checking and treating low iron and reviewing your medicines, which a GP does.
This guide covers what helps and how much, when to do Pilates, why your legs can feel restless after a class or during the relaxation at the end, which moves to use and change, pregnancy, and when to see a GP. It ends with a free 20-minute evening class.
18 moves18 with 3D demosThe short versionIron and medicinesWhen to do PilatesMovesFree classWarning signs
The short version
Iron and medicines come first
US sleep doctors ask for an iron check in everyone with troublesome RLS, and in a Cochrane review iron eased symptoms more than a dummy treatment. Some medicines, alcohol and caffeine can make RLS worse. A GP can check your iron and your medicines.
Exercise helps some people
In the one trial, walking and leg strength work 3 days a week cut symptom scores by 39% by week 6, though only 23 people finished. Gentle yoga helped in one small trial, and leg stretches helped in small trials in people on dialysis.
Harder work earlier, gentle stretching in the evening
The NHS says "exercise during the day" and not to do strenuous exercise late at night. In a survey of 528 people with RLS, over half said morning exercise helped and evening exercise made it worse. Our suggestion, from surveys and opinion rather than trials: harder classes in the morning or afternoon, gentle stretching in the early evening.
When your legs start, move
The NHS suggests walking, stretching or massaging your legs when you have symptoms. RLS comes on at rest, so if the relaxation at the end of a class sets it off, get up and walk.
Source 5
See a GP
See a GP if restless legs stop you sleeping, affect your mental health, or the things you've tried haven't helped.
Source 5
Restless legs syndrome
What it feels like
The NHS lists "a strong need to move your legs", "uncomfortable feelings in your legs, such as tingling, throbbing or itching" and "pain in your legs", usually worse at night when resting. NHS inform, which calls it Willis-Ekbom disease, says the feelings can often be relieved by moving or rubbing your legs.
How common it is
In a survey of 15,391 adults, 7.2% had some symptoms in a year and 2.7% had moderately or severely distressing symptoms at least twice a week. It's more common in women.
Iron, dopamine and other causes
The NHS says it's thought to be linked to iron and the brain chemical dopamine. Usually there's no clear cause, but it runs in families and is linked with pregnancy, iron deficiency anaemia, kidney disease and some medicines.
Sleep
NHS inform says up to 80% of people with RLS also have jerking leg movements in their sleep. US sleep doctors say about 9 in 10 people with RLS have trouble falling or staying asleep. Our Pilates for sleep guide covers winding down.
Lookalikes
Leg cramps (a sudden painful tightening, often in the calf) and nerve damage (peripheral neuropathy) can feel similar. Our exercise for restless legs guide sorts them out, and a swollen, painful leg can be a clot (see the warning signs).
Where Pilates fits
RLS comes on at rest and eases with movement, so two things in a Pilates class matter: moving and stretching your legs, which can ease symptoms while you do it, and lying still at the end, which can bring them on. Pilates leg work overlaps with the trial's strength exercises. It doesn't change your iron levels or replace the medicines that have the most evidence (our reading).
Iron and medicines first
Get your iron checked
The American Academy of Sleep Medicine (AASM) asks for ferritin and transferrin saturation (measures of iron) in everyone with troublesome RLS, and suggests iron if ferritin is 75 micrograms per litre or less or transferrin saturation is below 20%. Those cut-offs are higher than for anaemia, and are expert agreement "which have not been empirically tested".
Source 3
Iron helpsStrong evidence
In a Cochrane review, iron lowered symptom scores by about 4 points on a 0 to 40 scale against a dummy treatment (7 studies, 345 people; moderate certainty). Don't take extra iron without a GP's advice.
Things that make RLS worseStrong evidence
The AASM's first step is dealing with alcohol, caffeine, untreated sleep apnoea and some medicines, including sedating antihistamines, some antidepressants and anti-sickness medicines. A German guideline found too little evidence on coffee, alcohol and nicotine, so guidelines differ. Never stop a prescribed medicine yourself: ask your GP or pharmacist.
MedicinesStrong evidence
The AASM strongly recommends gabapentin, pregabalin and iron through a drip, and advises against the standard use of dopamine medicines, which can make RLS worse over time (augmentation). The NHS lists these and other medicines a GP may offer.
What the evidence says
No one has tested Pilates for restless legs. The evidence below is about walking, strength work, stretching, yoga and timing, and most of it is small.
No study of Pilates
Our searches of PubMed, Europe PMC and ClinicalTrials.gov in November 2026 found no published Pilates study in RLS. One is registered: 100 older adults on haemodialysis, 16 weeks, not yet recruiting in 2025 and with no results. In a US survey, one person listed the reformer among exercises that made their legs worse, and in a follow-up study another suggested a Pilates programme might help: opinions, not evidence.
Walking and leg strength: one trialEmerging evidence
In the only trial of aerobic and strength training in RLS outside dialysis, 41 adults were randomised and 23 finished. A 30-minute treadmill walk plus lower-body strength exercises, 3 days a week for 12 weeks, cut symptom scores by 39% by week 6, against under 8% in the comparison group, and the gain lasted to week 12. One person had knee pain. People knew which group they were in.
Source 6
Stretching: small trials, mostly on dialysisMixed evidence
In 33 people on haemodialysis, 30 minutes of leg stretches during dialysis, 3 times a week for 8 weeks, lowered symptom scores from about 19 to 12. A 2026 review of 8 trials on dialysis, all in Iran, rated the evidence very low certainty. Outside dialysis, a Turkish pilot with 6 people per group found scores fell with both treadmill exercise and stretching, but it's too small to rely on.
On dialysisEmerging evidence
A Cochrane review called the effects of treatments for RLS in kidney disease uncertain, though exercise lowered scores in 2 small studies. In a 6-month trial of 32 people, exercise during dialysis cut symptoms about as much as a dopamine medicine.
Yoga: one small trialEmerging evidence
In 41 adults (30 finished), 12 weeks of gentle Iyengar yoga eased symptoms more than an educational film programme, with no side effects reported. The AASM rated it low certainty and made no recommendation.
Reviews disagreeMixed evidence
A review of 11 trials found exercise among the treatments that helped, though the quality wasn't high; a 2025 review of 17 trials found no clear effect. The AASM didn't grade exercise because the studies were too limited, while a 2024 German guideline counts exercise and yoga among treatments with enough evidence.
Timing: surveys and opinion onlyMixed evidence
No trial has compared exercise at different times of day. In a US survey of 528 people with RLS, over half said morning exercise helped and evening exercise made symptoms worse, and 24% said exercise only made them worse. The German guideline says intense exercise in the afternoon or evening seems to worsen symptoms at night, and the trial's authors note that people with RLS often avoid vigorous exercise because of anecdotal reports that it makes symptoms worse.
When to do Pilates
What the NHS says
Exercise during the day, and don't eat a big meal or do strenuous exercise late at night. NHS inform says "do not exercise before bed", and lists walking and stretching, and relaxation exercises like yoga or tai chi, for an episode.
Our suggestion
Harder, longer or hot classes in the morning or afternoon; gentle stretching and leg circles in the early evening, a couple of hours before bed. The US RLS Foundation advises avoiding significant exertion within an hour or so of bedtime, and RLS-UK says some people find a gentle walk early in the evening helps. This comes from surveys and opinion, so notice what works for you.
Legs restless after a class
RLS comes on when you rest, so the still relaxation at the end of a class can set it off: get up and walk or stretch rather than lying through it. Some people also say hard or late exercise makes it worse. No study has looked at this in Pilates (our reading).
Give it time
In the exercise trial, symptoms had eased by week 6. If nothing has changed and RLS still stops you sleeping, see your GP.
Source 6
Earlier in the day: leg strength
The trial did 1 set of 8 to 12 for 2 weeks, then 2 sets, 3 days a week, with a 30-minute walk. Sit to stand, slow calf raise and glute bridge: 8 to 12 (the trial's dose; our home version). Wall side leg lift: "10 to 12 each side" (the move page's dose). Side kick: "8 to 10 each side" (the move page's dose). Inner thigh lift: "10 to 12 each side" (the move page's dose), standing in for the trial's hip adduction machine. Walk 30 minutes at a pace you can talk through.
3D demoTreadmill walkingBeginner · Cardio machine
3D demoSit to stand from a chairBeginner · A bench or box
3D demoSlow calf raiseBeginner · A wall
3D demoGlute bridgeBeginner · No equipment
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSide-lying inner thigh lift (Pilates side kick series)Beginner · No equipmentEarly evening: stretch and move your legs
Calf, soleus and hamstring stretches and the figure four: 30 seconds each side (our editorial starting point, as our exercise for restless legs guide uses them). Standing quad stretch: "Hold 20 to 30 seconds, 2 to 4 times each side" (the move page's dose), a hand on the wall. Single-leg circle: "5 circles each direction, each leg" (the move page's dose). Side-lying leg circles: "8 each direction, each side" (the move page's dose). Ankle circles: "10 slow circles each way with each foot" (the move page's dose).
3D demoWall calf stretch (gastrocnemius)Beginner · A wall
3D demoSoleus wall stretchBeginner · A wall
3D demoStanding quad stretchBeginner · A wall
3D demoSupine hamstring stretch with a strapBeginner · No equipment
3D demoReclined figure four (eye of the needle, Sucirandhrasana)Beginner · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoSide-lying leg circles (Pilates side kick series)Beginner · No equipment
3D demoAnkle circlesBeginner · No equipmentWind down, without lying still for long
Slow breathing: 1 to 2 minutes, about 4 counts in and 6 out (our bedtime Pilates class's dose, adapted from the move page's dose); the NHS points people with RLS to breathing exercises for stress. Windscreen wipers: "10 slow passes side to side, 2 rounds" (the move page's dose). Bent-knee fall-out: "2 sets of 5 to 10 each side, every other day" (the move page's dose).
Moves and classes to change
Long still rests
Long corpse pose, long legs-up-the-wall holds or a long reclining rest at the end of an evening class can set RLS off. If your legs start to feel restless, get up and walk or stretch (our suggestion, from the NHS's advice for symptoms).
Source 5
Hard or hot classes late in the evening
Take strong, hot or long classes earlier in the day (our suggestion, from the NHS's advice not to do strenuous exercise late at night).
Very hard sessions
Some people report that vigorous exercise makes RLS worse, and the RLS Foundation says it often does. Keep the effort moderate and see how your legs respond (our suggestion).
Caffeine before class
The NHS says no caffeine after midday, so skip caffeinated pre-workout drinks before an afternoon or evening class.
Source 5
Restless legs in pregnancy
Common, and usually goes after the birth
About 1 in 5 pregnant women get RLS, more as pregnancy goes on (8%, 16% and 22% by trimester), and only about 4% after the birth. The NHS says symptoms usually go away after giving birth.
What helps
In pregnancy, after the first trimester, keep time flat on your back to a few minutes: prop your upper body up, or use a side-lying or all-fours version.
The German guideline says moderate physical activity, yoga and massage can be recommended in pregnancy. Ask your midwife or GP about iron before taking supplements.
Classes to follow
Our evening class is for the early evening: a short walk, standing calf and thigh stretches, slow leg circles and side kicks, then slow breathing, with no long still rest. No trial has tested it: its order and doses are our editorial choice, from the NHS's advice to walk and stretch your legs, RLS-UK's daily stretching and small stretching trials. The restless legs exercises session is the trial's daytime walk and leg strength work. The bedtime classes suit the last hour before bed, but get up if your legs start to feel restless.
Evening Pilates for restless legs: a 20-minute leg stretch and wind-down class
A gentle 20-minute early-evening Pilates class for restless legs: a short walk, calf and thigh stretches, slow leg circles and side kicks, and slow breathing.
20 minBeginner14 movesA wall
Restless legs exercises: a daytime walk and leg strength
A 45-minute daytime session for restless legs, our editorial home version of the one exercise trial: a 30-minute walk, six leg strength moves and three stretches.
45 minBeginner10 movesCardio machine, A bench or box
Pilates leg workout: a 25-minute mat and standing class for your thighs
A 25-minute Pilates class for your legs: reformer footwork without the machine, leg circles, the side kick series, inner-thigh squeezes and stretches.
25 minBeginner15 movesA wall, Other / check instructions
Bedtime Pilates: a 15-minute wind-down on the floor
A slow 15-minute Pilates wind-down for the last hour before bed: slow breathing, small lying moves and a few minutes of stillness, with no effort or holds.
15 minBeginner9 movesFirm cushion
Bedtime stretch routine
A slow, 10-minute floor routine to unwind before sleep: child's pose, twists, happy baby and slow breathing.
10 minBeginner7 movesFirm cushion, A wallEasy cardio workout
A steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA plan to follow
The walking plan builds the daytime walking from the trial; do the evening class on other days.
Warning signs: when to get help
The restless legs lines are from our exercise for restless legs guide, word for word, and the heart lines from our other Pilates guides. 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.
Call 999 (911 in the US) or go to A&E
- Pain and swelling in one leg with breathlessness or chest pain: a blood clot may have travelled to your lungs.
- Chest pain that feels tight or squeezing, or spreads to your arms, neck or jaw.
Urgent GP appointment or NHS 111
- Throbbing pain and swelling in one leg (rarely both), usually in the calf or thigh, perhaps with red, blue or darkened skin or swollen veins: it could be a deep vein thrombosis (DVT).
- Severe burning pain in your legs and feet even when you rest, or toes turning cold and numb, then red or black: contact a GP immediately, or 111.
Source 28
See your GP
- Restless legs are stopping you sleeping or affecting your mental health, or self-help hasn't worked.
- Your RLS has been getting worse on a dopamine medicine: starting earlier in the day, coming on faster or spreading to your arms. Don't stop the medicine suddenly.
- You're pregnant and RLS is troubling you: ask about iron before taking supplements or medicines.
- Leg cramps disturb your sleep, last longer than 10 minutes, or come with numbness or swelling.
- Your legs ache when you walk and the ache goes after a few minutes' rest.
If you're struggling
Poor sleep can wear you down. If you have thoughts of harming yourself, call 999 or Samaritans on 116 123 (free, any time) in the UK, or call or text 988 in the US.
Chest pain or fainting: call 999
- 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.
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 32
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 33
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.
Source 33
Myths
"Stretching or Pilates cures restless legs"Strong evidence
No study of Pilates in RLS has been published, and the stretching trials are small, mostly on dialysis, with very low certainty. Iron, when it's low, and medicines have the most evidence.
"Exercise makes restless legs worse, so avoid it"Emerging evidence
In the one trial, walking and leg strength work cut symptom scores by 39% by week 6, and the NHS says exercise during the day. Hard exercise late in the evening is the part people say makes it worse.
"A normal blood count means iron isn't the problem"Emerging evidence
US sleep doctors suggest iron at a ferritin of 75 or less, higher than the usual cut-off for anaemia. These cut-offs are expert agreement, not trial results.
Source 3
"The relaxation at the end of class will settle my legs"
Lying still is when RLS comes on. The NHS suggests walking or stretching when symptoms start, so get up if your legs become restless.
Source 5
"It's just poor circulation"Strong evidence
RLS is thought to be linked to iron and dopamine in the brain. Leg pain from narrowed arteries comes on with walking and eases with rest, the opposite pattern: our exercise for restless legs guide explains the difference.
Source 5
Read next
- Exercises for restless legs
- Evening Pilates for restless legs: the 20-minute class
- Pilates for sleep
- Exercise for sleep
- Yoga for anxiety and sleep
- Exercise with anaemia
- Exercise with kidney disease
- Exercise for peripheral neuropathy
- Pilates for neuropathy
- Pilates in pregnancy
- Pilates for varicose veins
- Leg cramps
- Calf stretches
- Hamstring stretches
- Sleep calculator
Questions people ask
Is Pilates good for restless legs?
It can be a good fit: gentle leg stretches and slow leg circles in the early evening follow the NHS advice to walk and stretch, and leg strength work earlier in the day follows the one exercise trial. But no study has tested Pilates for restless legs, and iron and medicines have the most evidence.
Does Pilates help restless leg syndrome?
We don't know yet: the only Pilates study is registered, in older adults on dialysis, with no results. Walking and leg strength (one trial), stretching (small trials) and yoga (one trial) have some evidence.
Why do my legs feel restless after Pilates?
Restless legs come on when you rest, so the still relaxation at the end of a class can set them off; get up and walk or stretch. Some people also say hard or late exercise makes it worse, so do harder classes earlier in the day.
When is the best time to do Pilates with restless legs?
Harder classes in the morning or afternoon, and gentle stretching in the early evening. That's our suggestion from surveys and the NHS's advice to exercise during the day and avoid strenuous exercise late at night.
Which Pilates exercises help restless legs?
In the early evening: calf, hamstring and thigh stretches, slow leg circles on your back and side, and ankle circles. Earlier in the day: bridges, side kicks and inner thigh lifts for leg strength, as in the one exercise trial.
Is hot Pilates OK with restless legs?
It can be, but take hot or strong classes earlier in the day rather than late in the evening. That's our suggestion, from the NHS's advice not to do strenuous exercise late at night.
Should I get my iron checked for restless legs?
Yes, if restless legs bother you: US sleep doctors suggest iron treatment at a ferritin of 75 or less, higher than the usual anaemia cut-off, and a GP can test it. Don't take iron supplements without advice.
Can I do Pilates for restless legs in pregnancy?
Yes: about 1 in 5 pregnant women get restless legs, and it usually goes after the birth. After the first trimester, keep time flat on your back to a few minutes, and ask your midwife or GP about iron.
Is yoga or Pilates better for restless legs?
Yoga has one small trial showing benefit; Pilates has none yet. Either can be part of a gentle evening routine, so choose the one you'll keep doing.
Do stretches before bed stop restless legs?
They may ease them for some people: RLS-UK suggests daily stretching, and small trials in people on dialysis found leg stretches helped. They don't cure restless legs.
When should I see a GP about restless legs?
See a GP if restless legs stop you sleeping, affect your mental health, or the things you've tried haven't helped. Also see one if they're getting worse on a dopamine medicine, or if you're pregnant and they trouble you.
Sources
- PubMed, Europe PMC and ClinicalTrials.gov · Our searches for Pilates, yoga and exercise studies in restless legs syndrome (November 2026)
- ClinicalTrials.gov NCT07181746 · Pilates for restless legs in older adults on haemodialysis (registered 2025, not yet recruiting, no results)
- Winkelman 2025 · Treatment of restless legs syndrome (American Academy of Sleep Medicine guideline, J Clin Sleep Med; read in full)
- Trotti 2019 · Iron for restless legs syndrome: 10 trials (Cochrane review; read in full)
- NHS · Restless legs syndrome
- Aukerman 2006 · Walking and leg strength for restless legs syndrome (randomised trial, J Am Board Fam Med; read in full)
- Innes 2020 · Yoga against an educational film for restless legs syndrome: 41 adults (randomised trial, J Clin Sleep Med; read in full)
- Aliasgharpour 2016 · Leg stretches during dialysis for restless legs: 33 people (randomised trial, Asian J Sports Med; read in full)
- Cederberg 2024 · What 528 people with restless legs say about exercise (national survey, J Sleep Res; read in full)
- NHS inform · Restless legs syndrome
- Allen 2005 · Restless legs syndrome in 15,391 adults: the REST study (population survey, Arch Intern Med)
- Ohayon 2012 · How common restless legs syndrome is (review, Sleep Med Rev; read in full)
- NHS · Leg cramps
- Trenkwalder 2024 · Restless legs syndrome: abbreviated German guidelines (guideline, Neurol Res Pract; read in full)
- Cederberg 2024 · Designing an exercise programme with people with restless legs (stakeholder study, J Clin Sleep Med; read in full)
- Al-Harbi 2026 · Non-drug treatments for restless legs on dialysis: 8 trials (systematic review and network meta-analysis, Georgian Med News)
- Çoban 2023 · Aerobic exercise or stretching for restless legs syndrome: 18 adults (randomised pilot, Mov Disord Clin Pract; read in full)
- Gopaluni 2016 · Treatments for restless legs in kidney disease: 9 studies (Cochrane review; read in full)
- Giannaki 2013 · Exercise against a dopamine medicine for restless legs on dialysis: 32 people (randomised trial, BMC Nephrol; read in full)
- Winkelman 2025 · Treatments for restless legs syndrome (American Academy of Sleep Medicine systematic review and GRADE assessment, J Clin Sleep Med; read in full)
- Harrison 2019 · Non-drug treatments for restless legs syndrome: 11 trials (systematic review, Disabil Rehabil)
- Gupta 2025 · Non-drug treatments for restless legs syndrome: 17 trials (systematic review and meta-analysis, Ann Indian Acad Neurol; read in full)
- Restless Legs Syndrome Foundation (US) · Diagnosis and treatment
- RLS-UK · Non-medical treatments used to treat RLS
- Restless Legs Syndrome Foundation (US) · Frequently asked questions
- Chen 2018 · Restless legs syndrome in pregnancy: 27 studies (systematic review and meta-analysis, Sleep Med Rev)
- RLS-UK · RLS in pregnancy
- NHS · DVT (deep vein thrombosis)
- NHS · Heart attack
- NHS · Chest pain (past its review date: reviewed August 2023, review due August 2026)
- NHS · Fainting
- NHS · Shortness of breath
- NHS · Pilates for beginners (exercise video, with safety information)
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.