Pilates guide

Pilates for the thighs: fronts, backs and sides, strength and shape, why spot reduction doesn't work, the evidence, and a routine

Pilates works your thighs from every side: bridges and face-down kicks for the backs, side-lying lifts and side planks for the outsides, squeezes for the insides, and squats, wall sits and lunges for the fronts. In trials, mostly in older women who were doing little, it built leg strength, though reviews disagree on how much. What it can't do is take fat off your thighs: training one leg didn't slim that leg, even when its muscle grew, and the few studies that measured thighs after Pilates are too small and inconsistent to show any change.

It won't make your thighs bulky or longer either. Thigh muscle grows slowly even with hard training, and stretching doesn't lengthen muscles.

This guide covers the muscles on each side of your thigh, the moves that work them, what the trials show for strength, size and fat, why thighs store fat (and why that fat isn't the harmful kind), mat or reformer, how to make it harder, and the classes to follow. Thighs come in every shape, and nothing here promises a particular one.

The short version

Pilates works your thighs from every side

Face-down kicks and bridges work the backs, side-lying lifts and side planks the outsides (mostly the side of the hip), squeezes the insides, and standing, wall and chair work the fronts. Mat Pilates is mostly lying, so the fronts of your thighs need the standing work.

Sources 1, 2, 3, 4

No leg move slims that leg

Training one leg didn't take fat off it, even with heavy work that grew the muscle, and across 13 controlled studies there was no spot reduction. Thighs change, if they do, with the rest of you.

Sources 5, 6, 7

Pilates' effect on thigh size is barely studied

No trial in PubMed, the main medical database, has measured thigh girth against a comparison group. One small trial of 12 women a group reported smaller upper legs than the controls' after 12 weeks, but it contradicts itself and found the hips smaller too; the other report had no comparison group. None measured thigh fat on a scan.

Sources 8, 9, 10

It builds strength in people starting out, but reviews disagree on how much

The gains were shown mostly in older women. Small trials found stronger knees and hips, especially when the moves got harder over the weeks.

Sources 11, 12, 13

It won't make your thighs bulky, or longer

Leg lean mass didn't change on scans after Pilates; thigh muscle grows by only about 5% to 8% in 10 weeks even with hard, heavy training; and women build muscle at the same relative rate as men. Stretching doesn't lengthen muscle fibres.

Sources 14, 6, 15, 16

Thigh fat isn't the harmful kind

Fat on the hips and thighs goes with lower heart and diabetes risk in studies that follow people over time, and where your body stores fat is largely inherited. Thighs of every size do the same jobs.

Sources 17, 18, 19

Your thighs, side by side

The thigh from four sides

The front is the quadriceps, four muscles that straighten the knee (one of them, the rectus femoris, also lifts the thigh). The back is the hamstrings, which bend the knee and help straighten the hip. The inside is the adductors, which draw your legs together; our Pilates for inner thighs guide covers them. The outside is mostly the side hip muscles (gluteus medius and minimus and the tensor fasciae latae) running into the iliotibial band, a thick strip of connective tissue, not a muscle.

Where Pilates works each side

On the mat, one teaching platform says the shoulder bridge "will strengthen your hamstrings and glutes while increasing the flexibility of the front of the leg", the single-leg kick "strengthens the back extensors, the hamstrings, and the glutes", and the one leg circle "works the abdominals and provides pelvic stabilization and mobilization of the hip joint". Mat Pilates is mostly lying, so your legs lift only their own weight; standing and wall work (squats, lunges, wall sits) is where the front of the thigh carries your body (our reading). On the reformer, footwork presses the carriage away with the legs ("10x each position" on 4 springs), and later levels add work with the feet in straps, such as the frog; the Wunda chair's exercises "engage the core, legs, and arms".

Sources 20, 21, 22, 23

Why the thighs hold fat, especially in women

Where your body stores fat is mostly inherited: in 196 pairs of Danish twins, the heritability of lower-body fat was about 0.8. The female pattern of fat on the hips and thighs appears at puberty, and after the menopause fat tends to move towards the middle. Our guide to losing thigh fat explains this in full.

Sources 19, 24

Fat leaves in its own order

In 45 women training for 5 months, fat came mostly off the trunk, so the legs' share of fat rose; on a diet, the middle of the thigh lost proportionally more. The order varies and nobody can choose it (our reading). After liposuction of the hips or thighs, body fat came back, and more of it went to the tummy.

Sources 25, 26, 27

Shape is bone, muscle and fat

The width of your hips and the angle of your thigh bones are set by your skeleton, as our Pilates for hip dips guide explains; muscle adds a little size with hard training; fat changes with your whole body. Cellulite is common and isn't a sign of being unhealthy. Lipoedema, a painful build-up of fat in the legs that doesn't respond to diet, needs a GP (see the warning signs).

Strong thighs matter at every age

Your quadriceps get you out of a chair and up stairs. The NHS's strength exercises start with sit-to-stands from a chair: "Aim for 5 repetitions. The slower the repetitions, the better." Our Pilates for the lower body guide covers strength and balance in older adults.

Source 28

Why no leg move slims that leg

Training one leg doesn't take fat off itStrong evidence

Across 13 controlled studies of 1,158 people, mostly training one leg or one arm against the other: "Localized muscle training had no effect on localized adipose tissue depots, i.e., there was no spot reduction, regardless of the characteristics of the population and of the exercise program." Training one leg for 12 weeks took fat off the arms and trunk, but "this reduction was not achieved in the trained body segment". In 8 young women, one-legged cycling left the fat of the two thighs the same. In the largest trial, 181 adults aged 50 to 85 doing heavy one-leg knee extensions for about 10 weeks, the quadriceps grew, and "There were no significant changes in SCF or IMF" (the fat under the skin and between the muscles).

Sources 7, 5, 29, 6

A thinner pinch can be the muscle underneathEmerging evidence

A thinner fat layer over a trained thigh was "probably due to geometrical factors secondary to hypertrophy of the underlying muscle". In 104 adults training one arm, "MRI found a generalized subcutaneous fat loss independent of gender" (MRI is magnetic resonance imaging).

Sources 30, 31

The trial that disagreesMixed evidence

In 16 women, lower-body resistance training took more fat off the legs than the arms, but each group's cardio used the other limbs, so the design can't separate the two, and it hasn't been repeated. Fat beside a working thigh releases more fat during one session, but that hasn't added up to local fat loss in training trials.

Sources 32, 33

Inner- and outer-thigh moves

Our search found no study of inner- or outer-thigh exercises that measured the fat over those parts of the thigh.

Source 34

What the evidence says: Pilates, strength and thigh size

Thigh size after Pilates is barely studied, and the leg strength reviews disagree; most trials are small and in older women.

Thigh size after Pilates: one weak, inconsistent trialMixed evidence

Our searches found no trial in PubMed reporting thigh girth against a comparison group. One controlled trial, in a journal outside it, randomised 24 inactive women aged about 59 to mat Pilates 4 times a week for 12 weeks or no exercise. Afterwards the Pilates group's upper legs measured about 3 to 4 cm less than the controls', and their hips less too, but the paper compares only the end values, says the changes within each group weren't significant while its summary says they were, and doesn't make clear how the legs were measured. The only other Pilates study reporting thigh girth had no control group: in 20 Pilates-trained women, thigh, trunk and waist measurements fell.

Sources 8, 35, 36, 9, 10

No scan has shown Pilates adding thigh muscleEmerging evidence

Our search found no scan of the thigh muscles after Pilates. On DXA (dual-energy X-ray absorptiometry) scans, leg lean mass didn't change after 10 weeks of reformer and Cadillac classes (14.1 kg before and after), and teenage players gained lean mass in the trunk "but not in the leg". "No changes on body composition were detected." in 25 postmenopausal women. The one MRI study of Pilates and the hip muscles found no growth after 36 weeks, but it scanned from the lower back to the pubic bone, not the thighs.

Sources 37, 14, 38, 39, 40

Strength, without changing body compositionEmerging evidence

In 109 older women, Pilates improved strength and walking speed but "failed to induce any changes on body composition". Six months of weekly mat classes changed flexibility, not body composition.

Sources 41, 39, 42

Strength in older adults: gains, but the reviews disagreeMixed evidence

In 39 trials of people over 60, Pilates improved strength against no exercise by a moderate amount (moderate certainty), with strength tests pooled together rather than legs alone; 9 mat Pilates trials agreed. But a 2024 review of 24 trials (1,190 people) found "low quality evidence that Pilates did not significantly improve muscle strength compared to the control group", and two of its authors wrote one of the trials it pooled. Our Pilates for legs and lower body guides say the same.

Sources 11, 43, 12

Small trials of the fronts and backs of the thighsEmerging evidence

In 32 older women, Pilates beat static stretching for knee strength, though the same authors report other papers with identical group sizes, probably one sample. In 14 older women, "Repetitions increased every 4 weeks and the difficulty of exercises progressed from beginner to intermediate and advanced.", and knee and hip strength rose. Pilates and PNF stretching (proprioceptive neuromuscular facilitation) raised knee strength about equally. But in 44 adults with overweight, knee strength "did not change for any groups" after 8 weeks of Pilates or walking, and the newest review of women found no clear difference in leg strength.

Sources 44, 13, 45, 46, 47

Against other exercise, strength training includedEmerging evidence

"there is very low to low evidence that there is no difference between Pilates and other exercise modalities for dynamic strength, isometric strength, resistance strength, balance and flexibility". In 60 women aged 60 to 80, the resistance training group improved every measure of hip strength and the Pilates group one, with no difference between them. Mat and apparatus Pilates improved older women's chair stands about equally. No trial has compared Pilates with heavy, progressive leg training.

Sources 48, 49, 50

What builds the most thigh strengthStrong evidence

"voluntary strength was enhanced by lifting heavier loads (≥80% one-repetition maximum), through a complete range of motion, for 2-3 sets". Adults should strengthen the major muscles, legs included, on at least 2 days a week, and Pilates counts.

Sources 51, 52

Which moves work which side of your thigh

These figures come from single lab sessions: they show how hard a move works a muscle, not how much it will grow or what happens to the fat over it.

The back of the thighEmerging evidence

In healthy women, face-down leg beats worked one of the hamstrings at about half its maximum, and swimming at about 40%. The mat shoulder bridge worked the big glute more than a reformer hip roll.

Sources 1, 53

The front of the thighEmerging evidence

Wunda chair step-ups worked the front and back of the thigh "in the moderate and high categories", and a Pilates-style squat with drawing-in raised thigh activity in 13 people. On the reformer, how you push the footbar decides which muscles work, and you can't tell the load from the springs: "the estimation is imprecise".

Sources 4, 54, 55, 56

The outside of the thigh: the side of the hipEmerging evidence

Side-lying hip abduction worked gluteus medius at 81% of its maximum, against about 40% for clams. Across 56 studies, the single-leg bridge and side-lying abduction were among the best moves for gluteus medius, and side bridges worked it at over 69%.

Sources 2, 57, 58

The inside of the thighEmerging evidence

A ball squeeze between the knees worked the adductor longus at 118% of its reference. The teaser worked the adductors on the mat and the reformer alike ("No difference was found between Reformer and Mat."), and on the reformer, light springs worked the inner thigh more in side splits and heavy springs the side of the hip. Our Pilates for inner thighs guide goes further.

Sources 3, 59, 60

Not measured

Our searches found no muscle-activity study of the side kick series, leg circles, the single-leg kick, feet in straps, or standing and wall Pilates.

Sources 61, 62

A move that burns isn't necessarily growing the muscleEmerging evidence

Muscle activity in one session "is not a validated predictor of muscle hypertrophy", and in a hip thrust trial, higher glute activity "did not consistently predict gluteal hypertrophy outcomes".

Sources 63, 64

Will Pilates make my thighs bulky, or long and lean?

Women build muscle at the same relative rate as menStrong evidence

"relative increases in muscle size were similar between sexes" across 29 studies, and in adults over 50, "Females gained more relative lower-body strength than males". So the reason thighs don't get bulky by accident is the slow pace and the hard, progressive work it takes, not your sex.

Sources 15, 65, 66

Thigh muscle grows slowlyStrong evidence

Heavy one-leg knee extensions for about 10 weeks grew women's quadriceps by 7.5%; full squats twice a week for 10 weeks grew the knee straighteners by 4.9% and the adductors by 6.2% in men, while the hamstrings didn't change; loaded seated leg curls grew the hamstrings by 14% in 12 weeks. In women, resistance training builds muscle by a moderate amount over months.

Sources 6, 67, 68, 69

What grows muscleStrong evidence

"Muscle hypertrophy was enhanced by higher volumes (≥10 sets/wk) and eccentric overload." Light loads grow muscle about as well as heavy ones when sets are hard, but "increases in muscle strength are superior in high-load RT programs" (RT is resistance training). A Pilates class twice a week is well short of the hard sets it takes, which fits the lack of measured leg muscle growth (our reading).

Sources 51, 70, 71

Long and leanEmerging evidence

Stretching doesn't lengthen muscle fibres: "Neither acute nor chronic SS altered fascicle length." (SS is static stretching, across 65 studies). Where training did lengthen thigh fascicles, it was heavy loading, as the muscles grew. Our search found no study of muscle length or thigh shape after Pilates.

Sources 16, 72, 73, 74

CelluliteEmerging evidence

"Cellulite is a multifactorial condition that is present in 80-90 % of post-pubertal women.", and no treatment, exercise included, has good evidence. Our Pilates for cellulite guide covers it.

Sources 75, 76

Mat or reformer for your thighs

About equal for older womenEmerging evidence

Mat and apparatus Pilates improved older women's leg function about equally. Choose the one you'll keep doing.

Source 50

What the reformer adds

Footwork presses the carriage away against the springs, 10 times in each foot position, and feet-in-straps work such as the frog and side splits load the thighs in other directions. The springs make it easy to add load, but their setting doesn't tell you the force, and how you push changes which muscles do the work. These moves have no 3D demo here; our reformer Pilates guide describes them.

Sources 21, 22, 55, 56

How often, and how to make it harder

Twice a week, harder over the weeks

Twice a week counts towards the NHS strength guideline. The trials that found gains made the work harder every few weeks: one leg instead of two, slower lowering, a band, then hand weights, finishing each set when the last few reps are hard (our editorial starting point, from these trials and the strength position stand).

Sources 52, 13, 51

For more strength or size

Add squats, lunges or step-ups with weights on another day, about 10 or more hard sets a week for each muscle group, as our Pilates for the lower body guide says.

Source 51

For a smaller thigh measurement

The fat-loss half lives elsewhere: brisk activity on most days and eating a little less, as our guide to losing thigh fat explains. Both lower body fat overall, and your thighs follow in their own order.

Sources 77, 78, 25

The front of your thigh (quadriceps)

Squat: 2 sets of 10 slow reps, wall sit: 2 holds of 20 to 30 s, and reverse lunge: 8 each side (all our Pilates leg workout); harder, the goblet squat: 3 sets of 8 to 12 (our Pilates strength workout); sit to stand: 2 sets of 5 slow (our Pilates for balance class); split squat: 3 sets of 8 to 12 each side, and step-up: 2 to 3 sets of 8 to 10 each side (our lower body workout at home); reverse Nordic: 2 sets of 3 to 5 (our knee strengthening workout), left out if kneeling hurts the knee. Our Pilates for the quads guide covers the front of the thigh in full.

The back of your thigh (hamstrings)

Shoulder bridge: 3 to 5 kicks each leg (the classical sequence uses 3); single-leg kick: 6 to 8 each leg (the classical sequence uses 6); swimming: 2 to 3 sets of 20 to 30 seconds; wall bridge: "8 to 10 reps; one-leg version, 5 each side" (all from the move pages' doses); single-leg bridge: 6 to 8 each side (our Pilates lower body workout); slider hamstring curl: 3 sets of 6 to 12 (our lower body workout at home), the harder step outside Pilates.

The outside of your thigh (the side of your hip)

Side kick: 8 to 10 each side; side-lying leg circles: 8 each direction, each side; wall side leg lift: 10 to 12 each side (all from the move pages' doses); side-lying leg raise: 10 each side, heel leading and leg slightly behind your body line (our Pilates lower body workout); clamshell: 12 each side, with a band above the knees to progress (our Pilates glute workout); standing wall-press hip abduction: 3 to 5 holds of 5 to 15 seconds each side, twice a day: the standing hold in the LEAP trial programme (the move page's dose), the gentle option for a sore outer hip.

The inside of your thigh (adductors)

Ball squeeze: 6 holds of 5 to 10 s (our Pilates leg workout); inner thigh lift: 10 to 12 each side (from the move page's dose), left out with pain on the outside of the hip. Our Pilates for inner thighs guide has more.

Hip control on your back

Single-leg circle: 5 circles each direction, each leg (the classical sequence uses 5) (from the move page's dose).

Stretch the front and back of your thigh

Quad stretch: 2 holds of 20 to 30 s each side, and hamstring stretch with a strap: 30 s each side (both our Pilates leg workout); hip flexor stretch: 30 s each side, with the knee padded (our Pilates lower body workout). Stretching keeps your range; it doesn't make your thighs longer or slimmer.

Change or leave out

Our suggestions, unless a source is given.

Kneeling with sore knees, or after a knee replacement

Our knee strengthening workout says: "Kneeling hurts? Leave out the reverse Nordic and pad the split squat's back knee." Leave out the kneeling side kick too, as the knees line below says.

Pain on the outside of the hip

Don't lie on the sore side. The inner thigh lift's page says: "With pain on the outside of the hip, our suggestion is to leave this one out, as you'd either lie on the sore hip or cross that leg over the other." The side-lying leg raise's page says to start with lying and standing holds and bridges, and to "leave side-lying leg raises out while it hurts at night"; the standing wall press is the gentle option.

Ankle weights in side-lying lifts

They make the side of the hip work harder. Add them only once 15 controlled reps are easy, and leave them out with outer hip pain (our suggestion); our guide to ankle weights has the rules.

Holding your breath in squats and wall sits

Breathe out as you lift, and don't hold your breath.

Classes to follow

Our Pilates leg workout is the class for your thighs: standing footwork, leg circles, an inner-thigh squeeze, the shoulder bridge, the side kick series, lunges and stretches. Its tips say no leg move slims that leg, and that stronger or bigger legs need load added over the weeks. The lower body workout covers hips to calves with a harder option for every move; the inner thigh, glute and tight hamstrings classes take one side each; the strength workout adds weights; and the last two are the step to loaded leg training.

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 movesWall, other / check instructions

Hips-to-calves Pilates: a 30-minute lower body class with a harder option for every move

A 30-minute Pilates class for your whole lower body: footwork, bridges, side and face-down work, one-leg moves and a stretch, each with a harder option.

30 minBeginner20 movesWall, other / check instructions

Squeeze-and-lift Pilates for the inner thighs: a 20-minute mat and standing class with a ring, ball or cushion

A 20-minute Pilates class for your inner thighs: squeezes with a ring, ball or cushion, side-lying lifts, standing work and a short stretch, with a harder option.

20 minBeginner13 movesOther / check instructions, bench or box

Pilates glute workout: a 25-minute mat class (with a band if you have one)

A 25-minute Pilates class for your glutes: bridges, the side kick series, face-down kicks and standing work at a wall, with a band to make it harder.

25 minBeginner16 movesWall, band

Hamstring Pilates: a 25-minute class that works the backs of your legs, then stretches them

A 25-minute Pilates class for tight hamstrings: a warm-up, bridges and kicks that make them work, Pilates' moving stretches, then a few held stretches.

25 minBeginner17 movesDumbbell, other / check instructions

Pilates strength workout: a 30-minute class with weights or a band

A 30-minute Pilates strength class with dumbbells or a band: Pilates trunk work plus squats, lunges, rows and push-ups, each set taken until it is hard.

30 minIntermediate15 movesDumbbell, band

Lower body workout at home

A lower body workout at home: split squats, slider hamstring curls, single-leg bridges, step-ups, band walks and calf raises, with dumbbell options.

30 minIntermediate12 movesWall, step

Knee strengthening workout: from first steps to full range

A 25-minute session for knees that don't currently hurt: thigh and hamstring strength, single-leg control, then an optional full-range block with knees over toes.

25 minBeginner14 movesBench or box, wall

Plans

The 4-week Pilates plan is a gentle start, the glute plan and the squat challenge build leg strength step by step, and the walking plan is the fat-loss half, if that's your aim. None promises a new shape.

When your shape becomes a worry

Thigh searches are often body worries. Thighs that touch, thighs with cellulite and thighs of every size are normal.

Thigh fat and healthEmerging evidence

More fat on the hips and thighs goes with "a protective lipid and glucose profile, as well as a decrease in cardiovascular and metabolic risk". In 1,357 adults followed for 6 years, larger thighs went with lower diabetes risk in women, and in 72 cohorts each 5 cm more thigh went with a lower death rate (from only 3 studies). In 2,816 Danish adults, risk rose below a thigh circumference of about 60 cm, which the authors link to too little muscle. These are group links, never a size to aim for.

Sources 17, 18, 79, 80

Hips and legs that are painful and bruise easily

If your bottom, thighs and lower legs (sometimes your arms) are out of proportion with the rest of your body, feel painful, tender or heavy, and bruise easily, ask your GP about lipoedema, as our weight-loss and thigh fat guides explain.

Source 81

Signs of an eating disorder: see a GP

The NHS lists signs such as spending a lot of time worrying about your weight and body shape, exercising too much, and having very strict habits or routines around food. If that sounds like you, see a GP as soon as you can. You can also talk in confidence to the eating disorder charity Beat: 0808 801 0677 (England), 0808 801 0432 (Scotland), 0808 801 0433 (Wales) or 0808 801 0434 (Northern Ireland), 3pm to 8pm, Monday to Friday.

Sources 82, 83

Worrying a lot about one area of your body

If you worry a lot about one area of your body, spend a lot of time comparing your looks with other people's, or check or avoid mirrors, it can be body dysmorphic disorder (BDD). The NHS says "You should see a GP if you think you might have BDD." You can also refer yourself to NHS talking therapies (our suggestion, from the NHS page).

Source 84

Yoga and Pilates don't protect against itEmerging evidence

In a survey of 2,287 young adults, women who did yoga or Pilates had disordered eating as often as those who didn't, and men who did them reported more extreme weight-control behaviours (18.6% against 6.8%). Set goals for strength, control and how you feel, not calories burned.

Source 85

Who should change what

Sore knees, kneeling and replacements

Pilates Anytime says those with knee problems should avoid the kneeling side kick. Pad or skip kneeling, keep deep knee bends small while a knee is sore, and after a knee replacement don't kneel on the new knee until your doctor says you can, as the move pages advise. After a hip replacement, follow your team's precautions: the inner thigh lift crosses the top leg over, like crossing your legs. Our Pilates for knee pain guide has the detail.

Source 20

A pull at the back of the thigh

Stop if you feel a sudden sharp pain, a snap or a pop at the back of the thigh during a stretch: it may be a hamstring strain. Our hamstring strain guide says when to get help.

Wall sits and blood pressure

Wall sits raise blood pressure while you hold them, so breathe normally and never hold your breath. Ask your GP first if your blood pressure is 160/100 or higher and untreated, or if you have heart disease, and skip them with Marfan syndrome, vascular Ehlers-Danlos syndrome or aortic disease.

Very flexible joints

Keep stretches mild and in the middle of your range, and favour the strengthening moves: the NHS says not to overextend your joints just because you can.

Source 86

Pregnancy with pelvic girdle pain

Pregnant with pelvic girdle pain? Leave out the wide squats, Cossack squats and Copenhagen planks, which move your legs apart; the squeeze and bridges can stay.

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.

Living with a higher weight

Start where you're comfortable: chair, wall and standing versions all count. Our Pilates for plus-size bodies guide covers getting up and down from the floor and the equipment that helps.

Warning signs: when to get help

These are the warning signs of our hip, knee, thigh fat, legs and Pilates guides, word for word. 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 or go to A&E

  • Call 999 or go to A&E: severe hip pain after a fall or injury, or you cannot stand, walk or put weight on the leg. In an older adult this can be a broken hip; the leg may be at an odd angle or look shorter. Don't drive yourself.
  • Call 999 or go to A&E: tingling or loss of feeling in the hip or leg after an injury.
  • Leg pain or swelling with breathlessness or chest pain: call 999 or go to A&E, and do not drive yourself. It can be a blood clot that has reached the lungs.

Sources 87, 88

A clot that may have reached the lungs

If you have pain and swelling in a leg with shortness of breath or chest pain, or leg swelling with a tight, heavy or painful chest, coughing up blood, or feeling faint, confused or clammy: it could be a blood clot in the lungs. Don't drive yourself to A&E.

Sources 89, 90

The same day: a clot in the leg

Same day (urgent GP appointment or NHS 111): throbbing pain in one leg (rarely both), usually the calf or thigh; swelling in one leg (rarely both); red, blue or darkened skin around the painful area, which may be harder to see on brown or black skin; or swollen veins. This can be a deep vein thrombosis (DVT). It is more likely after surgery, a hospital stay, 3 or more days in bed, a journey of over 4 hours, pregnancy or a recent birth, cancer, a previous clot, or contraception or hormone replacement therapy (HRT) that contains oestrogen.

Source 89

The same day: a hot, swollen or injured hip or knee

  • Ask for an urgent GP appointment or get help from NHS 111 if you have severe hip pain that started suddenly but you've not had a fall or injured your hip, your hip is swollen and feels hot, the skin around your hip has changed colour, or you have hip pain, feel generally unwell and have a high temperature (or feel hot, cold or shivery). A hot, swollen hip with a high temperature can be a joint infection.
  • Get advice from NHS 111 now: a hot, red or swollen knee with sudden severe pain, a very high temperature, or feeling hot, cold or shivery. This can be a joint infection.
  • Get advice from NHS 111 now: you cannot move the knee or put any weight on it, or it is very painful, badly swollen or has changed shape.
  • You hurt your knee and cannot take 4 steps, or you are 55 or over and have injured it: get it checked the same day for a broken bone.
  • Same day (urgent GP appointment or NHS 111): throbbing pain in one leg (rarely both), usually the calf or thigh; swelling in one leg (rarely both); red, blue or darkened skin; or swollen veins; or sudden worse pain and swelling around a lump at the back of the knee (a possible clot or a burst Baker's cyst).
  • Get advice from NHS 111 now: the knee locks, gives way or clicks painfully. Painless clicking is normal.
  • Get advice from NHS 111 now: after a twist, your knee won't go fully straight, or something blocks the last part of straightening, even if you can still walk on it. A torn piece of meniscus caught in the joint can do this, and it needs checking promptly.

Sources 87, 88

A pulled muscle in the thigh or groin

Get help from NHS 111 if it's very painful or getting worse, there's a lot of swelling or bruising, you can't put weight on it or walk more than a few steps, it feels very stiff, or it isn't getting better with self-care. The NHS advises avoiding strenuous exercise for up to 8 weeks while it heals.

Source 91

See a GP or physiotherapist

  • Hip pain that stops normal activities or disturbs sleep, keeps getting worse or keeps coming back, or has not improved after 2 weeks of looking after it at home.
  • Stiffness lasting more than 30 minutes after waking.
  • Knee pain doesn't improve within a few weeks. In many areas you can refer yourself to NHS musculoskeletal (MSK) services, such as physiotherapy.

Sources 87, 88

Gaining weight you can't explain, in the NHS's words

The NHS lists health conditions that cause weight gain, such as an underactive thyroid, Cushing's syndrome and PMOS (polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome), and "certain medicines including some steroids, antidepressants and beta blockers". It says: "Speak to a GP for advice if you have a condition that makes it harder to stay a healthy weight." Don't stop a medicine without talking to your doctor (our suggestion).

Source 92

Chest pain or fainting while exercising: call 999

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 93, 94, 95

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 96

A heart condition

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.

Older adults

See your GP first if you get chest pain, breathlessness or dizziness when you are active, if you have a heart condition and want to exercise harder, or if you have had a fall.

Source 97

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 98

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, lung or joint condition, are pregnant or have recently been unwell, start gently and read our guide for your condition. Muscle soreness for a day or two after a new exercise is common and fades as you repeat it.

Source 98

Myths

"Pilates slims your thighs or gives you a thigh gap"Strong evidence

Training one leg didn't take fat off that leg, and across 13 controlled studies there was no spot reduction. The one small trial reporting smaller upper legs after Pilates contradicts itself and found the hips smaller too, so it says nothing about one spot. A gap between the thighs depends on your build (the width of your pelvis and the angle of your thigh bones) as well as fat and muscle, as our Pilates for legs guide says.

Sources 5, 29, 6, 7, 9

"Pilates makes your thighs bulky"Emerging evidence

Leg lean mass didn't change on DXA after Pilates; even heavy, targeted training grows thigh muscle by only about 5% to 8% in 10 weeks; and growth takes about 10 or more hard sets a week. Women build muscle at the same relative rate as men, so bulk isn't something that happens by accident to anyone.

Sources 14, 6, 67, 51, 15

"Pilates gives you long, lean thighs"Emerging evidence

Stretching doesn't lengthen muscle fibres, no study has measured muscle length or thigh shape after Pilates, and where thigh fascicles did lengthen, it was with heavy loading as the muscles grew. A toned look is some muscle with less fat over it, not a longer muscle.

Sources 16, 74, 73

"Inner and outer thigh moves burn the fat over them"Strong evidence

No exercise takes fat off the part it works. The outer thigh moves mostly work the side of the hip, and our Pilates for inner thighs guide covers the inner thigh.

Sources 7, 5, 2

"Light weights tone, heavy weights bulk"Emerging evidence

Muscle grows about as well with light or heavy loads when sets are hard, and heavy loads build more strength. Toning is the same process as building muscle, just less of it, as our Pilates for toning guide explains.

Sources 70, 71

"Fat on your thighs is the unhealthy kind"Emerging evidence

More fat on the hips and thighs goes with a healthier blood fat and sugar profile, and larger thighs with lower diabetes risk in women, in studies that follow people over time. The fat that matters most for health is around the middle, as our Pilates for the waist guide explains.

Sources 17, 18

"If a move burns, it's growing the muscle"Emerging evidence

Muscle activity in one session doesn't predict growth. The burn in a long set of leg lifts is fatigue, not a sign of growth or fat loss (our reading).

Sources 63, 64

Questions people ask

Is Pilates good for your thighs?

Yes, as strength work: bridges and face-down kicks for the backs, side-lying lifts for the outsides, squeezes for the insides, and standing work for the fronts. It built leg strength in trials, mostly in older women starting out, though reviews disagree on how much.

Does Pilates slim your thighs?

Not from one spot: training one leg didn't take fat off that leg, even when the muscle grew. The one small controlled trial that measured thigh girth after Pilates is too weak and inconsistent to rely on. Thighs change, if they do, with the rest of you, through moving more and eating a little less.

Can Pilates reduce thigh fat?

Only as part of losing fat overall, and Pilates is light work for that; brisk activity and eating a little less do more. Where fat comes off first is largely inherited and varies from person to person. Our guide to losing thigh fat has the whole plan.

Will Pilates make my thighs bigger or bulky?

Very unlikely: leg lean mass didn't change on scans after Pilates, and even heavy, targeted training grows thigh muscle only about 5% to 8% in 10 weeks. If your thighs feel bigger after starting, swelling after new exercise, weight changes or measuring differently are more likely causes.

Does Pilates tone your thighs?

Toned means some muscle with less fat over it. Pilates can strengthen the thigh muscles; how much they show depends on your overall body fat. Make the moves harder over the weeks if you want more muscle.

What are the best Pilates exercises for the thighs?

For the front, squats, wall sits, lunges and sit-to-stands; for the back, the shoulder bridge, single-leg bridge and face-down kicks; for the outside, side kicks, side-lying lifts and side planks; for the inside, the ball squeeze and inner thigh lift. Our Pilates leg workout puts most of them together.

Is reformer Pilates better for the thighs than mat?

Not clearly: mat and apparatus Pilates improved older women's leg function about equally. The reformer adds springs, but their setting doesn't tell you the load, and how you push changes which muscles work.

Can Pilates give me a thigh gap?

No exercise creates one: the gap depends on your build (the width of your pelvis and the angle of your thigh bones) as well as fat and muscle, and fat comes off the whole body, not one spot. Thighs that touch are normal at every size.

Does Pilates make your legs longer and leaner?

No exercise lengthens a muscle: stretching programmes didn't change muscle fibre length, and no study has measured thigh shape after Pilates. A leaner look comes from less fat overall and some muscle underneath.

Is thigh fat bad for your health?

Not in itself: more fat on the hips and thighs goes with lower heart and diabetes risk than fat around the middle. If your legs are painful, tender and out of proportion with the rest of you, ask your GP about lipoedema.

How often should I do Pilates for my thighs?

Twice a week counts towards the NHS strength guideline, and the trials that found gains made the work harder every few weeks. For more strength or size, add weighted squats, lunges or step-ups.

Can I do Pilates for my thighs with sore knees?

Usually, with changes: pad or skip kneeling, keep deep knee bends small while a knee is sore, and use bridges and side-lying work. Get advice from NHS 111 if your knee locks, gives way or is badly swollen.

Sources

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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.