Pilates is a good option for osteoarthritis, particularly in the knees and hips. Meta-analyses of randomized controlled trials show it improves both pain and physical function compared to doing nothing or continuing usual care alone. Major rheumatology guidelines recommend exercise as a core part of osteoarthritis management, and Pilates checks many of the boxes: it builds strength, improves flexibility, and can be scaled to your ability level without pounding your joints.
Why Pilates Works for Arthritic Joints
Osteoarthritis gets worse when the muscles around a joint weaken. In the knee, for example, declining quadriceps strength is closely tied to poorer joint position sense and lower limb function, both of which determine how disabled you feel day to day. Pilates directly addresses this by focusing on controlled, mostly isometric muscle contractions that strengthen the muscles surrounding a joint without forcing the joint through high-impact loading.
A key part of the benefit comes from the core. Pilates builds strength and endurance in your trunk and pelvic muscles, which improves stability further down the chain. Stronger core control changes the way forces travel through your hips and knees, distributing stress more evenly across the joint rather than concentrating it on damaged cartilage. This is why people with knee osteoarthritis often feel improvement even though Pilates isn’t targeting the knee directly in every exercise. The emphasis on breath control and body awareness also helps you move more efficiently, reducing the kind of awkward compensations that can flare up a painful joint.
What the Clinical Evidence Shows
A 2025 systematic review and meta-analysis published in the Annals of Medicine pooled data from multiple randomized controlled trials of Pilates for knee osteoarthritis. The results were clear: Pilates produced significantly better scores on the WOMAC scale (the standard measure of osteoarthritis pain, stiffness, and function) compared to people who received no structured exercise. The improvements showed up in both the overall score and the function-specific subscale, meaning people could do more in their daily lives with less difficulty.
For back-related osteoarthritis and chronic low back pain, the evidence follows a similar pattern. Pilates outperforms minimal intervention for pain reduction and functional improvement over both short-term and intermediate-term follow-ups. Some trials reached what researchers consider the minimum clinically important difference, meaning the improvement was large enough that patients could actually feel it in their daily routines, not just detect it on a questionnaire. Compared to other forms of exercise or hands-on treatments like massage, Pilates produces roughly equivalent outcomes, suggesting it’s a solid choice but not uniquely superior to all alternatives.
What the Guidelines Say
The 2023 EULAR recommendations for hip and knee osteoarthritis state that every person with the condition should be offered an exercise program that includes strength, aerobic, flexibility, or neuromotor training. The guidelines note that many exercise types improve pain and function, making it hard to recommend one modality over another. Pilates fits comfortably within this framework because it combines strength, flexibility, and neuromotor training (balance and coordination) in a single practice. The American College of Rheumatology similarly recommends exercise as a cornerstone of osteoarthritis management.
How Often and How Long
A scoping review in Sports Health examined Pilates dosing across rehabilitation studies for musculoskeletal conditions. Programs ranged from 6 to 16 weeks, but the most common effective structure was 8 weeks of sessions done twice per week, with each session lasting about 60 minutes and exercises performed for around 10 repetitions each. That’s a realistic commitment for most people: two hours a week for two months to see meaningful changes in pain and function.
Starting at twice a week gives your body enough stimulus to build strength while leaving recovery time between sessions. Some programs use three sessions per week, which may speed results but also increases the chance of overdoing it if your joints are particularly sensitive. After the initial 8-week period, continuing once or twice a week helps maintain what you’ve gained. Osteoarthritis is a long-term condition, and the benefits of exercise fade if you stop entirely.
Mat Pilates vs. Reformer
Both mat and reformer Pilates can work for osteoarthritis, and the clinical trials supporting Pilates for this condition have used various formats. The reformer has a practical advantage for people with stiffer or more painful joints: its spring-based resistance system lets you adjust the difficulty in small increments, and the sliding carriage supports your body weight during movements that might be uncomfortable on the floor. You can perform leg presses, for instance, while lying on your back with your body weight fully supported, loading the muscles around your knee without the compressive force of standing.
Mat Pilates is more accessible and cheaper, and it still delivers the core strengthening, balance training, and flexibility work that benefit osteoarthritis. The trade-off is that some mat exercises require you to support more of your own body weight, which can be challenging if you have significant knee or hip pain. If you’re starting with moderate to severe symptoms, reformer sessions with an instructor may be easier to adapt. If your symptoms are mild, mat classes are a perfectly reasonable starting point.
Potential Risks and How to Minimize Them
Pilates is generally low-risk, but it’s not completely without downsides. Physiotherapists surveyed about Pilates for back conditions identified a few potential issues: temporary increases in pain, aggravation of existing problems, excessive muscle tension, and the possibility of self-injury during exercises performed with poor form. These risks apply to osteoarthritis in any joint.
The most practical way to reduce risk is to work with an instructor who has experience with joint conditions, at least for the first several sessions. Pilates relies heavily on precise form, controlled movement, and proper breathing. When you’re learning, it’s easy to compensate with the wrong muscles or push through a range of motion your joint isn’t ready for. An instructor can modify exercises in real time: reducing the range of a leg circle if your hip catches, swapping a deep squat for a partial one, or using props like resistance bands and cushions to reduce joint strain. Once you understand the modifications your body needs, transitioning to home practice or group classes becomes much easier.
Avoid exercises that force a joint into deep flexion if that position is painful for you. Deep knee bends, full squats, and movements that require you to kneel with full body weight on the kneecap are common culprits. For spinal osteoarthritis, repeated loaded flexion (rounding forward under resistance) can aggravate symptoms. The beauty of Pilates is that most exercises have simpler variations. You rarely need to push into pain to get the benefit.
How Pilates Compares to Other Exercise
Pilates is not the only exercise that helps osteoarthritis, and the evidence doesn’t suggest it dramatically outperforms other structured programs. Walking, swimming, cycling, tai chi, yoga, and traditional strength training all have solid evidence behind them. What Pilates offers is a specific combination of low-impact strengthening, flexibility, balance training, and body awareness in a format that many people find more engaging than repetitive gym exercises.
For people who find weight-bearing exercise painful, Pilates (especially on a reformer) provides a way to build the stabilizing muscles around a joint without heavy loading. For people who already walk or swim regularly but still feel unstable or weak, adding Pilates can target the muscle control and proprioception that aerobic exercise alone doesn’t address well. The best exercise for osteoarthritis is ultimately the one you’ll actually do consistently, and for many people, Pilates fits that role well.