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Pilates

Upright Pilates for heart failure: a 35-minute sitting and standing class with a 15-minute warm-up, no lying flat and no breath holds

A class of about 33 minutes (37 with the optional side-lying block) for people with stable heart failure, after your cardiac rehab assessment or once your heart failure team agrees. It keeps everything sitting, standing or lying on your side, with a 15-minute warm-up, light strength work breathing out on each effort, and a seated cool-down of at least 10 minutes. You need a sturdy chair, a wall, a light band and, for the side-lying block, a mat or firm bed and a pillow. You should be able to talk all the way through. On a low day, do the warm-up and go straight to the cool-down. No trial has tested this class, so its structure is our editorial choice, following UK cardiac rehab standards.

35 minBeginner19 movesBench or box, wall, band, anchor point, something with weightHip flexors · Shoulders · Abs · Glutes · Quads · Hip abductors
Follow along: a timer, a cue and the next move, one step at a time.

Warm up, sitting then standing (about 15 minutes)

  1. Seated march3 min
    Beginner · Hip flexors, Quads, Abs · 3D demoEasy pace, sitting tall; you should be able to chat easilyHarder: Standing march
  2. Shoulder rolls10 each way
    Beginner · Shoulders, Back, Neck · 3D demoElbows by your sidesHarder: Shoulder CARs (controlled articular rotations)
  3. Lateral breathing (Pilates breathing)5 breaths
    Beginner · Abs · 3D demoSitting; breathe into the sides of your ribs, with no holdsHarder: Roll-up (Pilates)
  4. Breath reach3 breaths
    Beginner · 3D demoSeated; reach only as high as is comfortable. In the first weeks after a device, keep that elbow below shoulder heightHarder: Slow breathing (6 breaths a minute)
  5. Thoracic rotation5 each side
    Beginner · 3D demoSeated, arms crossed on your chest, turning from the ribsEasier: Side-lying open bookHarder: World's greatest stretch
  6. Seated march3 min
    Beginner · Hip flexors, Quads, Abs · 3D demoA little brisker. March standing if you feel well todayHarder: Standing march
  7. Standing hip CARs2 slow circles each leg
    Beginner · Glutes, Hip flexors, Hip abductors · 3D demoStanding with a hand on the wall. Seated: lift each knee a little and draw small circles with itEasier: Hip circles on all foursHarder: 90/90 hip lift-off
  8. Seated march4 min
    Beginner · Hip flexors, Quads, Abs · 3D demoBuild gradually until you're breathing a little harder but can still talk. On a low day, go straight to the cool-down from hereHarder: Standing march

Standing and seated strength (about 8 minutes)

  1. Sit to stand from a chair8 to 10
    Beginner · Quads, Glutes, Hamstrings · 3D demoBreathe out as you stand. If it's hard, push on your thighs or do 5Easier: Sit to stand, pushing on the thighsHarder: Bodyweight squat
  2. Wall side leg lift (standing side kick at the wall)10 each side
    Beginner · Hip abductors, Glutes, Abs · 3D demoA hand on the wallHarder: Lateral band walk, band at the feet
  3. Slow calf raise10 to 15 slow
    Beginner · Calves · 3D demoHold a chair backEasier: Seated bent-knee calf raise (soleus raise)Harder: Standing dumbbell calf raise
  4. Wall push-up8 to 10
    Beginner · Chest, Triceps, Shoulders · 3D demoBreathe out as you push away. After a new device, march on the spot instead until your clinic says arm work is fineHarder: Push-up
  5. Band row8 to 10
    Beginner · Back, Biceps, Shoulders · 3D demoA light band; breathe out as you pull. The same swap after a new deviceHarder: Supported single-arm dumbbell row
  6. Seated knee extension (chair)8 each leg
    Beginner · Quads · 3D demoStraighten slowly, lower more slowlyEasier: Quad set (static quads)Harder: Leg extension

On your side (about 4 minutes, optional)

  1. Side kick (Pilates side kick series)8 each side
    Beginner · Hip flexors, Glutes, Hip abductors · 3D demoHead on a pillow, on a mat or a firm bed; never flat on your backHarder: Side-lying leg circles (Pilates side kick series)
  2. Clamshell10 each side
    Beginner · Hip abductors, Glutes · 3D demoThen sit for a few breaths before you stand upEasier: Supine isometric hip abduction (belt press)Harder: Lateral band walk

Cool down sitting, and breathe (about 10 minutes)

  1. Seated march3 min
    Beginner · Hip flexors, Quads, Abs · 3D demoGradually slower, until your breathing is back to normalHarder: Standing march
  2. Cat-cow6 slow rounds
    Beginner · Back, Abs · 3D demoSeated, hands on your knees, head levelHarder: Half lord of the fishes (Ardha Matsyendrasana)
  3. Seated upper-back lift (sit tall, shoulders back)5 holds of 3 to 5 s
    Beginner · Back, Shoulders, Neck · 3D demoKeep breathingEasier: Elbows backHarder: Prone Y-T-W raises
  4. Mermaid (Pilates seated side bend)3 each direction, each side
    Beginner · Back, Abs, Shoulders · 3D demoOn a chair; on the device side, reach out to the side, not overheadHarder: Side bend (Pilates)
  5. Seated bent-knee calf raise (soleus raise)10 slow
    Beginner · Calves · 3D demoGentle heel lifts keep the blood moving as you cool downHarder: Slow calf raise
  6. Slow breathing (6 breaths a minute)5 min
    Beginner · 3D demoSitting, about 4 in and 6 out, no holdsEasier: Breath reachHarder: Crocodile breathing (prone diaphragmatic breathing)

Tips

  • Do this class after your cardiac rehab assessment, or once your heart failure team agrees. Keep walking or cycling on other days: Pilates is an extra, not your cardio.
  • Weigh yourself first if your team has asked you to. Skip the class if you've suddenly gained weight, your ankles or tummy are more swollen, or you feel unwell or more tired or breathless than normal, and contact your heart failure team.
  • You should be able to talk throughout. On a beta blocker, go by how it feels, not your heart rate.
  • Never hold your breath: breathe out on each effort. Leave out planks, floor press-ups and heavy weights.
  • Stand up slowly after sitting or side-lying work, and don't lie flat if it makes you breathless.
  • After a pacemaker or ICD (implanted defibrillator), keep that elbow below shoulder height and avoid arm strength work until your device clinic says otherwise, usually 4 to 6 weeks.
  • Stop if you get chest pain, palpitations, extreme breathlessness or light-headedness, or if you run out of energy, and get help for the warning signs in our Pilates for heart failure guide.

The doses are suggested starting points, not a prescription. Choose a range you can control and stop for sharp or increasing pain, numbness or tingling. Get individual advice after an injury or surgery, or if you are pregnant or managing a health condition.

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Questions people ask

How long does the upright pilates for heart failure: a 35-minute sitting and standing class with a 15-minute warm-up, no lying flat and no breath holds take?

About 35 minutes, including any warm-up and cool-down listed. Shorten it by doing fewer rounds; lengthen it by adding one.

What equipment do I need?

You need: A bench or box, A wall, A band, An anchor point, Something with weight. Each move links to its guide, where you can find an alternative if you are missing something.

Is it suitable for beginners?

It is written for beginners. 8 of its 19 moves have an easier option listed beside them if you need one.

How do I make it easier or harder?

Use the easier or harder option listed under each move, change the number of rounds, or adjust the rest. Progress one change at a time.