Pilates benefits: what the evidence shows, and a first routine on the mat

What Pilates is

Pilates is a method of controlled exercises, done on a mat or on equipment such as the reformer, a sliding carriage with springs. The work centres on the deep muscles of the trunk and hips, slow movement, precise alignment and breathing coordinated with each effort. Mat classes need only the floor and your body weight, sometimes a small ball or an elastic band.

It shares ground with yoga, which also builds flexibility and holds positions, and with core training such as the plank. The difference is the emphasis: Pilates is less about held postures and more about controlled repetitions.

What the research shows

• Low back pain. The Cochrane review by Yamato and colleagues included 10 trials and 510 people. Compared with minimal intervention, Pilates reduced pain with a medium effect in the short term, and moderate quality evidence supported an effect on pain and disability at three to twelve months. Compared with other exercise, results were mixed. The reviewers concluded that choosing Pilates can rest on preference and cost.
• Ranking against other exercise. The 2022 network meta-analysis by Fernández-Rodríguez and colleagues compared exercise types across 118 trials. All types helped except stretching for pain and the McKenzie method for disability. Pilates had the highest probability of being the most effective for pain (93%) and disability (98%). Its conclusion favoured at least one to two sessions a week of Pilates or strength exercise, sessions under 60 minutes, and Pilates programmes lasting three to nine weeks.
• Strength and flexibility. The NHS includes Pilates among activities that strengthen muscles and among those that improve flexibility.

The two reviews are not contradictory. Pilates works at least as well as other exercise for back pain, possibly a little better, and the best exercise is still the one you do regularly.

What Pilates does not cover

The 2024 Compendium of Physical Activities gives a traditional mat class 1.8 METs and a general Pilates class 2.8 METs, both below the threshold of 3 for moderate intensity. Pilates therefore counts towards your strength and flexibility work, but you still need the 150 minutes of moderate aerobic activity the World Health Organization recommends. See how much exercise per week.

It is also light on heavy loading. For bone and muscle mass with age, add lifting or other resistance work over time.

A first mat routine

Do each exercise slowly for about 45 seconds, both sides where relevant, then repeat the circuit once. Breathe out on the effort.

1. Pelvic curl. Lying on your back, knees bent, roll the spine up one vertebra at a time into a bridge, then roll down.
2. The hundred, modified. Head and shoulders lifted, feet on the floor or knees bent above the hips, pump the arms in small beats while breathing steadily.
3. Single leg stretch. Head lifted, draw one knee in while the other leg extends, then switch, keeping the lower back steady.
4. Side-lying leg lift. On your side, lift and lower the top leg with the hips stacked.
5. Swimming. Face down, lift opposite arm and leg a few centimetres, alternating, without arching hard.
6. Spine stretch forward. Sitting tall, legs apart, reach forward and round the spine gently, then roll back up.

The calculator below gives the length of this sequence and checks it against the ACSM figure for flexibility: 60 seconds in total per exercise.

How often, and how to progress

The NHS recommends strengthening activities on at least two days a week; the 2022 analysis found benefits with one to two Pilates sessions a week. Two classes of 45 to 55 minutes is a sound target.

• Weeks 1 to 4: a beginners' class, focusing on breathing and neutral spine.
• Weeks 5 to 8: add a 15-minute home session from the routine above.
• After two months: try intermediate classes or the reformer, where springs add resistance.

At the start, a teacher who corrects your alignment helps more than a video. Pilates also pairs well with a weekly stretching routine and with yoga for those who enjoy both.

Precautions

Pilates is low impact, and the two Cochrane trials that reported adverse events found none or only minor ones. Still:

• Avoid holding your breath during effort.
• If an exercise brings sharp pain, tingling or pain down a leg, stop and choose an easier variation.
• After pregnancy, or with a known disc problem or osteoporosis, ask for adapted exercises.

If your back pain is new, severe, getting worse or comes with numbness, weakness or bladder changes, see a doctor before starting Pilates. With chronic back pain, a physiotherapist can tell you which exercises to start with.

Keep Pilates in a regular week with Never Skip Club

Pilates works when it becomes a habit, and your week still needs aerobic work and some heavier strength sessions. Create your free account, launch a guided session in a minute on the days without a class, and start a crew with friends: the ranking rewards regularity, not extra sessions. If you want an expert to check your form, find a coach from our network, or sign in to pick up where you left off.