Pilates guide
Pilates suits many older adults: it is low impact, it can be done on a mat, on a chair or at a wall, and it counts toward the advice for over-65s to do strength, balance and flexibility activities on at least 2 days a week. In trials of people aged 60 and over, it improved balance test scores, flexibility and everyday function.
It hasn't been shown to reduce the number of falls or to build bone, so it works best alongside walking, standing balance exercise and strength training.
This guide covers balance and falls, strength and bones, which moves to swap if you have osteoporosis, Pilates after a joint replacement and with high blood pressure, what chair Pilates is and how to choose a class, with moves and a chair Pilates workout to follow.
UK guidelines ask adults over 65 to do activities that improve strength, balance and flexibility on at least 2 days a week. The NHS lists Pilates as a muscle-strengthening activity, and a UK consensus on osteoporosis names it among the balance and strength exercises to do at least twice a week.
Reviews of 20 and 39 studies found Pilates improved balance test scores in people aged 60 and over. One found better fall-risk scores, but the newest, of 39 studies, found no drop in the number of falls.
Trials found no significant change in bone density. Pilates helps balance and posture; for your bones, the UK consensus recommends strength training and impact exercise.
"Generally, Pilates is very safe and won't cause a spinal fracture", the Royal Osteoporosis Society says. As a precaution, swap moves that round your back under load, such as the roll-down, roll-up and curl-up, and leave out rolling like a ball and the roll-over.
Seated exercise builds some strength but didn't improve balance in trials, so use the chair as a starting point and add standing moves, holding the chair, as soon as you can.
If you're frail, have moderate to severe dementia, have had a spinal fracture or fall regularly, start any new exercise with a trained professional. Look for a small class with a teacher trained to work with older people.
Pilates trials in older adults mostly enrolled people aged 60 or over, and one falls trial took people aged 61 to 84. The UK Chief Medical Officers' guidance for older adults starts at 65.
Usually, Pilates-based exercise on an ordinary chair, sitting or standing with the chair for support. The NHS chair-based Pilates workout is for people who have difficulty getting down on the floor, and some of its moves are chair-only, for people who can't stand.
In a studio, a chair class can also mean the Wunda chair, one of the pieces of apparatus Joseph Pilates designed, which is a different class altogether. Check which one a class means before you book.
Trials measure balance with clinic tests, such as the Berg Balance Scale or the timed up and go test. A falls trial counts actual falls over months. A better test score is encouraging, but it isn't proof of fewer falls.
The Royal Osteoporosis Society explains that some Pilates moves can "over flex" the spine, especially quick, repeated or uncontrolled forward bending, or bending under load, which puts uneven pressure on the front of the spine. The UK consensus says its advice here rests on expert agreement rather than trials, because the evidence is limited. So the swaps are a precaution, and Pilates itself is encouraged.
A 2023 review of 20 trials (930 people, average ages 63 to 79) found a moderate improvement in balance, pooling 13 of them. A review of 39 studies found a smaller effect, at low certainty, and the newest review, of 39 studies and 1,770 people, found better balance at very low to moderate certainty, about the same as other exercise gives. Smaller reviews agree. Many trials were small and not blinded.
One review found a large improvement in fall-risk scores, at moderate certainty, though its summary doesn't say how fall risk was measured. The newest review found Pilates did not reduce the number of falls or fear of falling. Only one small study in an earlier review counted falls, and a pilot trial of 53 people aged 61 to 84 found 42% fewer fall injuries, a difference that could have been chance.
In the Pilates trials that described their exercises, only 2% to 36% of exercises challenged balance moderately or strongly. The world falls guidelines strongly recommend balance-challenging and functional exercise, such as sit-to-stands and stepping, 3 or more times a week, progressed for at least 12 weeks. In a Cochrane review, balance and functional exercise cut the rate of falls by 24% (high certainty).
The world falls guidelines note that supervised classes such as Pilates or yoga had the largest effects on concern about falling in two reviews, and one Pilates review found less fear of falling. The newest Pilates review found no effect.
One review found a moderate gain in strength compared with no exercise. Another, of 24 trials (1,190 people), found no significant gain compared with no exercise, at low certainty, and no difference from other exercise, at moderate certainty; its authors don't recommend Pilates as a way to build strength.
Across 6 trials, people were about 0.9 seconds faster on the timed up and go test after Pilates, and other reviews found better flexibility and everyday function, at low certainty. Across 51 studies of adults over 55, Pilates improved physical measures moderately compared with no exercise.
Three trials in women after the menopause, and 11 studies of Pilates or yoga in 591 women, found no significant change in bone density. In people at higher risk of fracture, the effect on bone and falls was uncertain, though physical function and quality of life improved a little.
In a trial of 99 adults aged 60 to 88 with a rounded upper back (kyphosis), a physiotherapist-led programme of back strengthening and posture training, 3 times a week for 6 months, reduced the curve by 3 degrees more than in the comparison group. That wasn't Pilates, but it is the kind of back work the UK consensus recommends.
In 34 healthy adults over 60, 10 weeks of Pilates slightly reduced the upper-back curve when standing, with no comparison group. In 20 women aged 55 to 65, 12 weeks of water-based Pilates reduced the curve by about 2 degrees. A review of 9 studies reported better posture, but their quality varied. Expect small changes at most.
In people with high blood pressure, 4 trials and 7 other studies found Pilates lowered blood pressure by about 5 mmHg (the top number) and 3 mmHg (the bottom number) compared with comparison groups. It was safe, but not shown to beat other exercise.
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In 110 women aged 60 or over, 12 weeks of Pilates improved word fluency and planning skills but not overall thinking scores. A trial of 28 women with mild memory problems had no inactive comparison group. These are small trials, so no promises, though the UK guidelines note strong support for physical activity in general lowering the risk of dementia.
Most of these are precautions agreed by experts, not trial results. Each move's page has the details.
Do balance and strength exercise, including Pilates, at least twice a week, and back-strengthening exercises repeated 3 to 5 times and held for 3 to 5 seconds, at least twice a week. Modify or avoid moves that bend the spine forward for a long time, repeatedly or to the end of its range, especially with a load.
"As a precaution, alternatives to exercises such as the 'roll down' and 'curl up' in Pilates should be considered." People who are experienced and move comfortably and smoothly can carry on. Twisting is fine if it's smooth and comfortable.
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If you have osteoporosis or a higher risk of fracture, the society suggests:
The consensus suggests yoga and Pilates to help posture and pain, ideally in a class led by an instructor trained to work with older people or osteoporosis, plus breathing and pelvic floor exercises for symptoms of a severe curve. If your fractures were painless, or have healed and the pain has gone, going back to your usual exercise is your choice, the society says. See a physiotherapist first if fractures are still causing pain.
Pilates hasn't been shown to build bone. For that, the UK consensus says impact exercise combined with progressive strength training works best; our osteoporosis guide has the detail.
A small case series used modified Pilates after hip and knee replacements without early complications, and in 34 people after a knee replacement, adding Pilates-based exercise to standard rehabilitation improved balance and quality of life more than standard exercise alone. That's little evidence, so your surgical team and physiotherapist decide when to start.
While you recover, the NHS advice after a hip replacement includes not crossing your legs, not bending your hip more than 90 degrees, not bending down to touch your feet and not sitting in low chairs or chairs without arms. After a knee replacement it includes avoiding twisting the knee, not crossing your legs for 6 weeks and not kneeling on the new knee until your doctor says you can. In Pilates terms (our suggestion), that rules out deep knee-to-chest moves, the roll-up and deep forward folds with a new hip, and kneeling moves with a new knee, until you're cleared.
Holding your breath while straining sharply raises blood pressure: in experienced lifters lifting heavy weights to failure, it peaked at an average of 320/250 mmHg. European heart guidelines advise avoiding it, especially with high blood pressure. Pilates loads are light, but breathe out on the effort and keep breathing through every move.
Our suggestion: if your blood pressure isn't under control, leave out moves that put your head below your heart, such as the roll-over and jack knife, and come up slowly from forward folds. Our high blood pressure guide covers exercise in more detail.
Across 14 trials, seated exercise improved thinking skills a lot, and strength, spinal movement, activity, mood and quality of life a little, but had "no effect on balance or mobility", and did no better than standing exercise. Across 25 studies of chair-based exercise in adults over 50, people could do about 2 more chair stands and about 3 more arm curls in 30 seconds.
Experts agreed that chair-based exercise is mainly seated, that the chair is there for stability in both sitting and standing, and that, where possible, it should be "a starting point to progress to standing programmes".
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We found no trials of chair or seated Pilates in older adults (a search of Europe PMC, October 2026). The only seated Pilates trial we found was a small study in people with multiple sclerosis, in which balance improved.
The NHS suggests a solid, stable chair without wheels, with a flat, firm seat and backrest, where you can sit with your feet flat and your knees at right angles. It suggests a chair without arms, which would restrict your movement. After a hip replacement, follow your physiotherapist: the NHS advises against low chairs and chairs without arms while you recover.
The UK guidelines for over-65s: strength, balance and flexibility activities on at least 2 days a week, plus 150 minutes a week of moderate activity such as brisk walking, built up gradually. Pilates twice a week covers the first part; it doesn't replace walking. The NHS balance exercises suggest doing balance work at least twice a week, near a wall or a stable chair.
The World Health Organization (WHO) asks older adults to do varied activity that emphasises balance and strength on 3 or more days a week, and the world falls guidelines recommend balance-challenging exercise 3 or more times a week for at least 12 weeks. For people who are already falling, the UK consensus recommends a falls service and about 3 hours a week of challenging balance and strength training for at least 4 months.
Two Pilates sessions a week of 20 to 45 minutes, on a chair or a mat, walking on most days, and standing balance work on a third day if falls are a concern. The trials used 60-minute classes twice a week for 10 to 12 weeks.
The UK consensus suggests classes led, if possible, by an instructor trained to work with older people or people with osteoporosis, who can adapt exercises to your ability and range of movement. The Royal Osteoporosis Society suggests a small class where everyone gets good supervision.
Before the class, tell your teacher about osteoporosis or past fractures, a joint replacement, falls, high blood pressure or dizziness, so they can suggest swaps (our suggestion).
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Mat, chair, reformer and wall classes differ. A chair class may use an ordinary chair or the Wunda chair, a piece of Pilates apparatus. Our reformer and wall Pilates guides explain those formats.
UK physiotherapists must be registered with the Health and Care Professions Council, and you can check the register online. For a Pilates instructor, ask about their training and their experience with older adults.
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Sit near the front of a firm chair, feet flat. The NHS sitting exercises use 5 twists each side with a 5-second hold and 5 marches each leg, and the UK consensus suggests 3 to 5 upper-back lifts held for 3 to 5 seconds; other doses are on each move's page. The chin tuck, twist and breath reach are shown standing: do them seated.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoChin tuckBeginner · No equipment
3D demoSeated marchBeginner · A bench or box
3D demoSeated overhead side bendBeginner · A bench or box
3D demoThoracic rotationBeginner · No equipment
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box
3D demoTable slide (seated forward reach)Beginner · A bench or box
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoChair leg extension and sweepBeginner · A bench or box
3D demoBreath reachBeginner · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipment
3D demoSpine twist (Pilates)Beginner · No equipmentThese are the moves that train balance. Hold the back of a sturdy chair or a worktop, or stand by a wall: the NHS balance exercises suggest doing them near a wall or chair, at least twice a week. With osteoporosis, do the wall roll-down with your hands on your thighs and a small range.
3D demoSit to stand, pushing on the thighsBeginner · A bench or box
3D demoSit to stand from a chairBeginner · A bench or box
3D demoStanding marchBeginner · No equipment
3D demoSlow calf raiseBeginner · A wall
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoSingle-leg standBeginner · A wall
3D demoTandem stance and heel-to-toe walkBeginner · A wall
3D demoSide-stepping (sideways walking)Beginner · A wall
3D demoWall push-upBeginner · A wall
3D demoWall angelBeginner · A wall
3D demoWall roll-down (wall Pilates)Beginner · A wallThese follow the osteoporosis swaps: the knee fold instead of curl-ups, the pelvic curl only part of the way up, the hip roll with your feet down, and back extensions (swan, locust, swimming) held for 3 to 5 seconds, 3 to 5 times.
3D demoKnee foldBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoHip Windshield WipersBeginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSide-lying leg raiseBeginner · No equipment
3D demoCat-cowBeginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoLocust pose (Salabhasana)Beginner · No equipment
3D demoSwimming (Pilates)Intermediate · No equipmentThe chair Pilates workout is seated, with a standing finish holding the chair. The beginner Pilates for over-50s session is on a mat, with no curl-ups or roll-downs. For falls and bones, add the balance routine and the bone-strengthening workout.
A 20-minute chair Pilates workout for beginners and older adults: breathing, sitting tall, gentle spine and leg moves, and a standing finish at the chair.
20 minBeginner14 movesA bench or box, Something with weightA 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 wallA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxStrength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.
45 minBeginner14 movesA wall, A dumbbellA 30-minute routine for a rounded upper back in later life, built from the SHEAF trial: floor back-strengthening, posture practice and gentle mobility.
30 minBeginner13 movesA bench or box, A wallImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsA 20-minute beginner wall Pilates workout: standing and floor moves that use a wall for support and feedback. No equipment.
20 minBeginner9 movesA wallStrength, bone-loading and balance on 3 days a week plus walking, following the UK osteoporosis consensus.
You're frail, have moderate to severe dementia, have had a spinal fracture or fall regularly: the UK guidelines suggest any new exercise is supervised by a trained professional at first.
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The Royal Osteoporosis Society suggests a physiotherapist first if you:
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Stop if you feel any of these, and call 111, or 999 (911 in the US) in an emergency:
See your doctor about back pain, or a change in body shape such as losing height or a more curved back: these can be signs of a spinal fracture, though not all spinal fractures hurt.
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If you fall repeatedly, or have started avoiding activity because you're worried about falling, ask your GP about a local falls service.
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Follow your surgical team's precautions, and ask your physiotherapist before starting Pilates.
Pilates improves balance, but the newest review found no reduction in the number of falls, and the one pilot trial that counted fall injuries couldn't rule out chance. Exercise that prevents falls challenges balance 3 or more times a week.
Trials found no significant change in bone density. Impact exercise and progressive strength training build bone.
"Generally, Pilates is very safe and won't cause a spinal fracture", the Royal Osteoporosis Society says. The UK consensus recommends Pilates among balance and strength activities and suggests swapping a few moves.
Seated exercise had no effect on balance or mobility in 14 trials. Use the chair as a starting point, then stand.
Trials included people in their 80s, and the UK guidelines say the benefits of activity for older adults outweigh the risks.
Yes: in trials of people aged 60 and over, it improved balance test scores, flexibility and everyday function, and it counts toward the advice for over-65s to do strength, balance and flexibility activities on at least 2 days a week. The NHS describes Pilates as suitable for people of all ages and fitness levels.
Not proven. Pilates improves balance tests, but the newest review found it didn't reduce the number of falls. To cut falls, add balance-challenging standing exercise 3 or more times a week.
Pilates-based exercise done sitting, or standing with a chair for support, for people who find getting down to the floor hard. In a studio, a chair class can also mean the Wunda chair, a piece of Pilates apparatus, so check before you book.
It's a good way in and builds some strength, but seated exercise didn't improve balance in trials. Use it as a starting point and add standing moves, holding the chair, as soon as you can.
Yes, with a few swaps: the Royal Osteoporosis Society says Pilates is generally very safe and won't cause a spinal fracture. Modify moves that round your back under load, such as the roll-down, roll-up and curl-up, and leave out rolling like a ball and the roll-over.
It hasn't been shown to: trials found no significant change in bone density. Pilates helps posture and balance; for your bones, add impact exercise and progressive strength training, as our osteoporosis guide explains.
Back-strengthening exercise reduced the curve a little, by 3 degrees, in a 6-month trial, and Pilates studies are small. The seated upper-back lift and small back extensions, such as the swan, are the moves to use.
Often yes, once your surgical team agrees: small studies suggest it's feasible and may help balance. While you recover, follow your precautions: after a hip replacement, no crossed legs and no bending the hip past 90 degrees; after a knee replacement, no kneeling until your doctor says so.
Yes, and it may lower blood pressure slightly, by about 5/3 mmHg. Keep breathing throughout, because holding your breath while straining raises blood pressure sharply, and get blood pressure that isn't under control treated first.
Twice a week fits the advice to do strength, balance and flexibility activities on at least 2 days a week. Add walking or other aerobic activity, and balance work on a third day if falls are a worry.
Look for a small class with a teacher trained to work with older people or osteoporosis, who adapts moves to you. Tell them about any fractures, joint replacements or falls, and if you're frail, have had a spinal fracture or fall often, start with supervised exercise.
Small trials suggest benefits for some thinking skills, such as word fluency and planning, but not enough to promise it. Physical activity in general is linked with a lower risk of dementia, the UK guidelines say.
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.
