Pilates guide
The vagus nerve links your brain with your heart, lungs and gut, and it slows your heart. Pilates can't reset it, and resetting the vagus nerve isn't a medical term. What studies measure is heart rate variability, an indirect sign of the vagus nerve's effect on the heart, and the most reliable way to raise it is slow breathing, at about 6 breaths a minute.
Pilates has its own way of breathing, and slowed down on purpose it becomes that kind of breathing; as usually taught, it measured no slower than normal breathing in the one small study that checked. A handful of small Pilates trials have measured heart rate variability, with mixed results, and none has shown more than other exercise does.
This guide covers what the vagus nerve does, what heart rate variability can and can't tell you, slow breathing and the long out-breath, what the Pilates trials found, the "vagus nerve exercises" you'll see online, vagus nerve stimulation as a medical treatment, fainting, and a calm Pilates practice.
It runs from the brainstem through the neck and chest to the abdomen, slows the heart and helps run digestion and breathing. Most of its traffic carries news from your organs up to the brain; the often-quoted 80% figure for that goes back to a 1957 study.
Our searches found no research at all on "vagus nerve reset", "vagus nerve exercises" or "vagal toning", and none of the Pilates trials measured anything called a reset.
Heart rate variability, the small beat-to-beat changes in your heart rate, reflects the vagus nerve's effect on the heart. But changing how fast and deeply you breathe changes the reading directly, without changing the nerve's activity, and wearables at night differed from a heart trace by about 6% to 16%.
Across 223 studies, slow breathing raised heart rate variability during practice, straight after it and after a course, peaking at about 6 breaths a minute. In the one small study that measured Pilates breathing, people breathed about 16 times a minute, no slower than normal. Slow it down on purpose: about 4 seconds in and 6 out, or 5 and 5.
Of four trials that compared Pilates with no exercise, two small ones found higher resting heart rate variability, one found only overall measures rose, not the ones linked to the vagus nerve, and the best-published found no change. Several were read only as abstracts or are small secondary analyses.
It uses an implanted or handheld electrical device. NICE (the National Institute for Health and Care Excellence) says to consider an implanted stimulator for some people with epilepsy, allows it for depression and some headaches only with special arrangements, and supports a handheld neck device for cluster headache. Pilates is no substitute.
"It is the tenth cranial nerve, extending from its origin in the brainstem through the neck and the thorax down to the abdomen." In the chest, "it provides the main parasympathetic supply to the heart and stimulates a reduction in the heart rate". Its biggest job is carrying information from the gut, liver, heart and lungs to the brain.
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The 80% figure you'll often see is quoted from a 1957 study, so "most of its fibres" is the safer way to put it.
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As you breathe in, the brain eases off the vagus nerve's hold on the heart and your heart rate rises a little; as you breathe out, the hold returns and your heart slows. That's the true part of the idea that the out-breath calms you.
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Our yoga for the vagus nerve guide answers the same question for yoga, our vagus gadgets guide covers devices and cold water, our physiological sigh guide the sigh, and our somatic Pilates guide claims about "nervous system regulation".
"Heart rate accelerates during inspiration and slows down during expiration, a phenomenon that is called respiratory sinus arrhythmia." Heart rate variability "is able to index cardiac vagal tone", and the measure called RMSSD (the root mean square of successive differences) is the one least affected by breathing.
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"Shifts in respiration rate and volume can markedly change HRV indices (HF power, RSA, pNN50, RMSSD) without actually affecting vagal tone." So a higher reading while you breathe slowly is partly the breathing itself, and the reading and the nerve's activity can come apart.
Several Pilates trials report a low frequency to high frequency (LF/HF) ratio as a balance of the two halves of the nervous system, but "the LF/HF sympatho-vagal balance hypothesis has been disproven".
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In 13 healthy adults over 536 nights, five consumer devices differed from a heart trace by about 6% to 16% for night-time heart rate variability. A watch can show your own trend over weeks, not your vagal tone.
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In 223 studies, breathing slowly raised the part of heart rate variability linked to the vagus nerve, during practice, straight after and after a course. "Maximum HRV is typically observed at about a respiratory frequency of 6 breaths per min (0.1 Hz)", and any rate from 5 to 7 a minute worked in 75 athletes. The slow rate works by keeping time with the body's blood pressure reflex.
In 84 students, "Breathing at 6 bpm increased HRV measures more than square or 4-7-8 breathing with small to medium effects. None of the breathing conditions resulted in meaningful changes in blood pressure or mood." Some people over-breathed a little at 6 a minute, so keep the breaths soft.
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Breathwork eased stress a little across 12 trials of 785 adults, and slow breathing before bed improved how people rated their sleep in 9 studies, though sleep measured by devices was unclear. In a month-long trial of 108 people, a long-exhale breath lifted mood more than mindfulness, but heart rate variability didn't differ between the groups. The NHS breathing exercise for stress counts "from 1 to 5" and says "Repeat for at least 5 minutes".
"The specific respiration of the Pilates method is known as lateral breathing, which avoids expansion of the abdomen". In the one study that measured it, 15 healthy people breathed about 16 times a minute with Pilates breathing, the same as their normal breathing, and about 12 with tummy breathing. Pilates breathing is mainly taught to switch on the deep trunk muscles. This rests on one small study, and teachers cue breathing differently; slow it down on purpose if calm is what you want.
In some short lab studies (30 and 28 people), a longer out-breath raised heart rate variability a little more. But in an original study and a repeat at 6 breaths a minute, the ratio of in-breath to out-breath made no difference, and in a 12-week trial of 100 adults, slow breathing eased anxiety whether or not the out-breath was longer, while resting heart rate variability didn't change. The researchers wrote that the long exhale's extra calming effect "has not been demonstrated".
The idea that breathing "stimulates" the vagus nerve comes from a theory paper, not a test. Before a stress test, a long out-breath and box breathing worked equally, and heart rate variability didn't change with either.
Holding your breath and bearing down while lifting very heavy weights sent blood pressure very high in athletes, far higher than breathing out through the effort. The health risk of short breath holds isn't proven, and Pilates loads are much lighter, but Pilates already teaches breathing out on the effort: keep the breath moving.
About a dozen small studies, mostly from Brazil, Korea and Turkey, many in journals with a low bar; our search found no review of Pilates and heart rate variability.
In 54 healthy men, 12 weeks of Pilates raised overall heart rate variability, not the measures linked to the vagus nerve (abstract only). In 60 women with high blood pressure, in a secondary analysis, vagal measures rose with mat Pilates but not when walking was added. In 45 women with obesity, a third of whom dropped out, they rose with face-to-face Pilates. In 28 women with high blood pressure, in the best-published trial (read as an abstract), 24-hour blood pressure fell 10.3 mmHg more with Pilates while "HRV indices did not change".
In 24 stressed adults, Pilates and yoga changed heart rhythm measures about equally, and the vagal measure didn't change significantly. In 32 women, 12 weeks of mat Pilates changed no heart rate variability measure. In 40 young women, not randomised, the vagal measure rose only in the group that added 5-seconds-in, 5-seconds-out breathing to Pilates: a weak hint that the breathing is what matters.
In 15 women, vagal measures fell during reformer, Cadillac and chair sessions and "returned to the normal range within 40 min". Harder Pilates levels lowered them for the first minutes after a session, as other group classes do. After one session in 13 people with high blood pressure, vagal activity was lower than after rest, and one session of mat Pilates didn't change heart rate variability in 16 women. The calm you feel after a class is real; it isn't a measured vagal boost.
Regular exercise raised resting vagal heart rate variability a little in sedentary people, and in healthy adults across 16 trials in a journal with a low bar. In older adults, more sessions a week gave bigger gains, and strength training did little in healthy people. Pilates, as exercise, would be expected to do roughly what other moderate exercise does; its own trials don't show more.
The largest review of Pilates and mental health (32 trials, 1,264 people) found quality of life and self-esteem improved, but no significant effect on depression or anxiety, with every trial at some or high risk of bias; an older review of 8 small trials had found bigger effects. For depression, many kinds of exercise help a little, in a 218-trial review that had no Pilates group. Our Pilates for stress and anxiety guide covers this.
A review of 14 yoga trials, only 2 of acceptable quality, found "no convincing evidence" that yoga changes heart rate variability, and another of 59 studies called conclusions "premature". In 36 people, yogic breathing raised it only while they practised, not at rest after two weeks.
Lower heart rate variability goes with anxiety, only weakly, and with inflammation in observational studies, which can't show cause. No trial shows Pilates lowers inflammation through the vagus nerve.
In 24 adults, humming slowed breathing and raised heart rate variability, and blocking the sound with noise-cancelling earphones changed nothing: the effect seems to come from "extended exhalation rather than the vibratory sound itself". Humming equalled plain slow breathing in 16 adults. It also raises nitric oxide in the nose 15-fold, a sinus effect.
Brief cold on the side of the neck changed a short heart rate variability reading in a lab, and cold water after exercise sped vagal recovery in mostly athletic people, while stretching, massage and other recovery methods didn't. Our vagus gadgets guide covers cold plunges and their risks.
Laughter raised heart rate and lowered heart rate variability, much like exercise. An electrical ear stimulator didn't help rheumatoid arthritis in 113 people, and we found no study of ear massage, gargling or eye-movement exercises for the vagus nerve.
We found no study testing them. Gentle neck movement is fine; our Pilates for neck pain guide covers it.
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NICE says: "If resective epilepsy surgery is not suitable for a person with drug-resistant seizures, consider vagus nerve stimulation as an add-on treatment to antiseizure medication." The NHS lists "putting a small electrical device under the skin on your chest to help reduce seizures (vagus nerve stimulation)" among epilepsy treatments.
For depression, "Evidence on its efficacy is limited in quality", so NICE allows an implant only with special arrangements; for cluster headache and migraine, neck stimulation's "evidence on efficacy is limited in quantity and quality". NICE supports a handheld neck device for cluster headache.
In a trial paid for by the maker, 35.2% of 242 people with rheumatoid arthritis improved with an implanted stimulator against 24.2% with a sham after 3 months; an ear stimulator didn't help. The effect comes from a surgically implanted device, not from breathing or exercise.
Many "regulation" and "freeze state" claims rest on the polyvagal theory. In 2026, 39 experts concluded "All co-authors agree that major tenets of the PVT are not supported by past or current knowledge", and that a key idea, the dorsal vagal shutdown, "in humans is, thus, completely without evidence". The theory's author replied that the critique fails to engage the theory on its own terms. Our somatic Pilates and yoga for the vagus nerve guides say the same.
Slow breathing: "At least 5 minutes, done regularly as part of your daily routine" (from the move page's dose), about 4 seconds in and 6 out. Lateral breathing: 5 to 8 breaths at the start of a session (from the move page's dose), slowed to about 4 in and 6 out (our suggestion). Crocodile breathing: 5 minutes of easy nose breathing, about 4 in and 6 out (from the move page's dose). Breath reach: "5 breaths, exhale longer than inhale" (the move page's dose).
Doses from our slow somatic Pilates class: pelvic tilt into bridge, 6 slow reps; heel slide, 5 slow each side; knee fall-out, 5 each side; windscreen wipers, 10 slow passes; side-lying open book, 5 each side; mermaid, 2 each direction, each side. Cat-cow: "8 waves, slower than feels natural" (the move page's dose). Go at about half your usual speed.
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoBent-knee fall-outBeginner · No equipment
3D demoHip windshield wipersBeginner · No equipment
3D demoCat-cowBeginner · No equipment
3D demoSide-lying open bookBeginner · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipmentThe Hundred: 50 beats to start, building to 100 (from the move page's dose); its breath is 5 pumps in and 5 out, so at about one beat a second each breath takes 10 seconds, or 6 a minute (our arithmetic; no study has measured breathing during the Hundred). Swimming: 2 to 3 sets of 20 to 30 seconds, and side kick: 8 to 10 each side (both from the move pages' doses). Rest your head down if your neck aches.
Child's pose: 1 minute (our slow somatic class). Corpse pose: lie still for at least 5 minutes, up to 10 (from the move page's dose); eyes open is fine. Legs up the wall: 2 minutes, with your hips on the floor if you have glaucoma or high blood pressure that isn't controlled (as our yoga for the vagus nerve guide says). Get up slowly.
Not needed: 6 breaths a minute raised heart rate variability more than box or 4-7-8 breathing, which use holds.
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Fast techniques such as "breath of fire" aren't part of Pilates, and in trials of yogic breathing, "Adverse events were more frequently associated with fast than with slow breathing techniques."
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Breathe out on the effort rather than holding your breath and bearing down, as Pilates teaches.
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Come up from lying in stages: roll to your side, sit for a few breaths, then stand (our suggestion; the warning signs below have the site's line on light-headedness).
Our editorial plan, from the slow breathing studies (Laborde 2022, Marchant 2025), the NHS breathing exercise for stress, and the exercise and heart rate variability reviews. No study has tested this plan.
See the movement on the 3D figure: Slow breathing (6 breaths a minute)
There is no vagus nerve class on purpose: no trial has tested one, and the slow somatic class already starts with 4-in, 6-out breathing. Use the slow and crocodile breathing in the breathing routine; its box and 4-7-8 rounds are optional. The stress relief workout suits a short break, the restless legs class an evening wind-down, and the beginner and walk-and-Pilates classes the days with more effort.
A slow, 20-minute Pilates class with time to notice your breath and how each move feels. Every move is optional and you can pause or stop at any point.
20 minBeginner12 movesNo equipmentA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentA 12-minute reset for stressful days: 4 minutes of brisk movement, 3 minutes to loosen your neck, shoulders and back, then 5 minutes of slow breathing.
12 minBeginner10 movesBench or box, wallA 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 movesWallA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentA 45-minute session for weight loss and health: a 20-minute brisk walk, which does more for the scales, then a short-rest Pilates circuit for strength.
45 minBeginner11 movesCardio machineGet up from the floor in stages, keep legs up the wall and long lying holds short, and use the fainting lines below. Our Pilates for low blood pressure and Pilates for PoTS guides cover the moves to change.
Follow the breathing advice your own team gives you, as the slow breathing move's caution says.
Keep your eyes open, keep practices short and breathe slowly without holds. Our Pilates for PTSD guide has more.
If you have an implanted or handheld vagus nerve stimulator, follow your specialist team's advice on activity (our suggestion; we found no Pilates study). Pilates doesn't replace the stimulator, your medicines or your team's plan.
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Slow breathing and gentle Pilates are safe for most people. 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 if:
Call 999 if someone has any of these, and don't drive yourself to A&E:
If you feel faint, stop, lie down and raise your legs. Use the counter-manoeuvres if you can't lie down.
Lie down and raise your legs until you feel better. If you can't lie down, sit, if possible with your head lowered between your knees, and drink some water.
Cross one leg in front of the other while standing, then tense your leg muscles and clench your buttock and tummy muscles. You can also rock up and down on your toes, or clench your fists. Keep breathing while you hold the squeeze, sit or lie down as soon as you can, and practise when you're well so the moves come quickly (our suggestions).
In 223 people who fainted repeatedly and got warning signs, learning these moves cut the share who fainted again from 50.9% to 31.6% over about 14 months, in a trial where everyone knew their group. In people over 40 with little warning, the difference wasn't clear, and reviews rate the evidence low. US heart rhythm specialists say they "can be useful" with enough warning, and US first aid guidance recommends them. A Pilates class doesn't treat fainting.
The NHS says fainting is "not usually a sign of something serious, but if it happens you should see a GP".
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Dizziness or light-headedness when you stand up or change position can be a drop in blood pressure (postural hypotension), not vertigo. Get up slowly, from lying to sitting to standing, and see a GP if you keep getting dizzy or fainting. Our exercise for PoTS guide covers postural tachycardia syndrome.
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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.
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If a breathing practice makes you dizzy, light-headed or tingly, you're probably breathing too deeply: make the breaths smaller or go back to normal breathing. If you get wheezy or tight-chested, stop and follow your action plan (our suggestions).
If you feel dizzy, light-headed or tingly, make the breaths smaller or breathe normally. If strong feelings come up, stop, open your eyes, sit up and look around (the slow breathing move's caution and our somatic class's advice).
If lying still brings up distressing thoughts or panic, open your eyes, sit up and breathe slowly; if slow breathing makes you dizzy or tingly, make the breaths smaller (our advice).
Never do fast breathing or breath holds before or during swimming: over-breathing before going underwater has caused blackouts and drownings (our suggestion, from a US case series of 16 people, 4 of whom died).
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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.
If you're struggling to cope with stress, the things you're trying aren't helping, or you'd like a referral; or if you think you might have generalised anxiety disorder, or treatment isn't helping. Adults can also refer themselves to NHS talking therapies.
Call 999 for chest pain that feels tight or like squeezing, or spreads to your arms, neck or jaw, or for palpitations with chest pain, breathlessness or fainting. Panic can feel similar: if you're not sure whether it's panic or your heart, treat it as your heart (our advice).
NICE's treatments for generalised anxiety disorder are talking therapies such as CBT or applied relaxation, and the NHS may also offer medicines. Exercise, including Pilates, is an addition, not a replacement.
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.
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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.
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Reset isn't a medical term and no study has measured one. Pilates trials of resting heart rate variability disagree, and the best-published found no change.
Your heart slows a little on each out-breath, but no study shows the breath or the diaphragm massaging the nerve: the idea comes from a theory paper. At 6 breaths a minute a longer out-breath didn't change heart rate variability, and over 12 weeks it added nothing over equal breaths.
Measured once, Pilates breathing was no slower than normal breathing; slow breathing at about 6 a minute is what raises heart rate variability. Slow it down on purpose.
Straight after a session, vagal measures are lower, not higher, and recover within about 40 minutes, as after any exercise. Feeling calm afterwards is real; it isn't a measured vagal boost.
Humming works by slowing your out-breath; blocking the sound changed nothing. We found no studies of gargling or ear massage, and an electrical ear device didn't help arthritis.
It shows heart rate variability, which your breathing changes directly, and night-time readings differed from a heart trace by about 6% to 16%. Follow your own trend, not one number.
Experts found no evidence for dorsal vagal shutdown in people; the theory's author disputes their critique. Feeling shut down or numb is worth talking to a GP about.
The largest review found no significant effect on anxiety, though quality of life and self-esteem improved, and none of the mood trials measured the vagus nerve. NICE's treatments for anxiety are talking therapies, with exercise as an addition.
Reformer, Cadillac and chair sessions affected heart rate variability the same way in 15 women, and slow breathing needs no equipment.
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Pilates can help you breathe slowly, move and feel calmer, and slow breathing raises heart rate variability, an indirect sign of vagus nerve activity on the heart. Pilates itself hasn't been shown to change the vagus nerve: the few small trials disagree. It's a good way to practise slow breathing, not a nerve treatment.
Not in the sense of a medical stimulator, which is an electrical device. During and just after a Pilates session, vagal measures actually dip and recover within about 40 minutes, as after any exercise. Slow breathing raises heart rate variability while you do it.
Slow it down: about 4 seconds in and 6 out, or 5 and 5, which is about 6 breaths a minute. Usual Pilates breathing, measured once, was no slower than normal breathing. Don't hold your breath, and make the breaths smaller if you feel dizzy.
Your heart slows a little on every out-breath, so a longer one can feel calming. But at 6 breaths a minute a longer out-breath didn't raise heart rate variability, and in a 12-week trial it added nothing over equal breaths. Slow, comfortable breathing is what counts.
Reset isn't a medical term, and no study has measured one. Slow breathing and regular exercise help how you feel, and a little with stress. Our somatic Pilates guide covers nervous system regulation claims.
Not more than other kinds: in 15 women, reformer, Cadillac and chair sessions affected heart rate variability the same way. Slow breathing needs no equipment.
It may help how you feel about yourself and your quality of life, but across 32 trials the effect on anxiety and low mood wasn't significant. If anxiety is affecting your life, see a GP: NICE's treatments are talking therapies, and exercise is an addition. Our Pilates for stress and anxiety guide has more.
It measures heart rate variability, which your breathing changes directly, and night-time readings differed from a heart trace by about 6% to 16%. Watch your own trend over weeks, not one number.
Humming works by slowing your out-breath, cold water changes a short reading in a lab and has real risks, and we found no studies of gargling or ear massage. Our vagus gadgets guide covers cold plunges and devices.
Pilates doesn't treat fainting. If you feel faint, stop, lie down and raise your legs; if you can't, crossing your legs and tensing your muscles can raise your blood pressure within seconds. See a GP if you have fainted, and get up from the floor slowly.
Follow your specialist team's advice on activity; we found no Pilates study. Pilates doesn't replace the stimulator, your medicines or your team's plan.
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.
