Is Pilates Good for Osteoarthritis: Benefits and Risks

Pilates can meaningfully reduce pain and improve daily function in people with osteoarthritis, particularly knee osteoarthritis, when compared to not exercising at all. Two recent systematic reviews pooling data from randomized controlled trials confirm the benefit over inactivity, though neither found Pilates to be clearly superior to other forms of exercise. The distinction matters: Pilates is a solid option, not a magic one, and the evidence base is still relatively small and sometimes low in quality. For anyone living with stiff, aching joints and looking for a low-impact way to stay active, Pilates deserves serious consideration alongside other exercise approaches.

What the Research Actually Shows

The strongest evidence for Pilates and osteoarthritis comes from knee OA, which is where nearly all the clinical trials have focused. A 2025 meta-analysis that pooled eight randomized controlled trials involving 322 participants found that Pilates significantly improved overall knee function scores compared to people who received no exercise intervention at all.¹ A separate meta-analysis published around the same time, drawing on overlapping but not identical trials, likewise found that Pilates reduced pain compared to no intervention, based on three studies involving 66 participants.²

Here is where the story gets more nuanced. When Pilates was compared to other active exercise programs rather than to doing nothing, neither meta-analysis found a clear advantage. The first reported no significant differences in pain, function, or range of motion between Pilates and other exercise types.¹ The second came to a similar conclusion across five studies involving about 210 participants, finding no superiority over conventional exercises for pain relief.²

The practical takeaway is straightforward: Pilates works, but probably not because of anything uniquely special about its movement vocabulary. It works because it gets you moving in a controlled, joint-friendly way. If you already enjoy and stick with another form of exercise, the research does not suggest you need to switch. If you find conventional gym exercises boring or intimidating, Pilates offers comparable benefits in a format many people find more appealing.

Pain Relief and Everyday Function

The pooled analyses tell a broad story, but some of the individual trials offer a more vivid picture of what Pilates can do for someone dealing with knee OA on a daily basis. A randomized controlled trial of older women with knee osteoarthritis found large improvements in both pain and functional capacity after a mat Pilates program. Pain scores on a validated questionnaire dropped by roughly two-thirds, and functional capacity roughly doubled, over the course of the intervention.³ The control group, which did not participate in Pilates, showed no improvement in any of those measures.

General health status also improved only in the Pilates group, not the controls.³ That finding hints at something that purely pain-focused outcome measures can miss: feeling stronger and more capable in your body tends to have a broader effect on how you rate your own health. When you can get up from a chair without wincing, walk further without needing to stop, or carry a grocery bag without dreading the stairs, daily life just feels different.

A pilot study that combined pain neuroscience education with a Pilates program found that both the combined group and a comparison group improved after eight weeks, with no significant difference between them for pain, physical limitation, or function.⁴ That result reinforces the theme from the meta-analyses: Pilates reliably improves things, but the improvements tend to be in the same ballpark as other structured exercise approaches.

Range of Motion and Joint Flexibility

One area where Pilates may have a slight edge is joint range of motion. The second meta-analysis found a statistically significant improvement in knee range of motion among Pilates participants compared to those doing conventional exercises, based on two studies involving 70 participants.² The consistency of the finding across those two studies was encouraging, with no statistical variability between them.

This makes intuitive sense if you have ever taken a Pilates class. A lot of the movements emphasize controlled, end-range joint motion: slow leg circles, articulated spinal movements, gradual deepening of hip flexion and extension. Traditional strengthening exercises tend to focus more on building force in a mid-range position. For someone whose knee feels stiff and whose instinct is to avoid bending it fully, the Pilates approach of gently exploring and expanding available range can be a useful counterweight to that protective guarding.

That said, the first meta-analysis did not find a significant range-of-motion advantage for Pilates, even when comparing it to health education alone.¹ So the evidence is mixed. The range-of-motion benefit is plausible and supported by some data, but it is not yet a slam dunk.

Balance and Fall Prevention

Osteoarthritis does not just hurt. It changes how you move. Knee and hip OA can alter your gait, reduce your confidence on uneven ground, and increase your risk of falling. This is where Pilates offers something that goes beyond just managing the arthritic joint itself. A study of older adults found that a Pilates-based exercise program improved mobility, postural stability, and balance on several validated tests, and participants also reported feeling less afraid of falling.⁵

Reduced fear of falling is easy to overlook, but it matters. When people become afraid of falling, they tend to restrict their own activity, which accelerates the muscle loss and deconditioning that made them unsteady in the first place. A form of exercise that simultaneously strengthens muscles, challenges balance, and builds confidence can interrupt that cycle. Because Pilates emphasizes core stability and asks you to control your limbs while maintaining a stable trunk, it trains exactly the neuromuscular coordination that keeps you upright.

That said, Pilates is not the only game in town for balance. A trial comparing Pilates training to suspension training (using straps anchored from above) in women with knee OA found that the suspension training group actually did better on measures of dynamic balance, static balance, range of motion, and motor performance.⁶ Suspension training places a high demand on stabilizing muscles because the support surface is inherently unstable. If balance improvement is your top priority and you have access to both options, suspension-based exercise might be the stronger choice, though Pilates still produced meaningful gains.

Safety and What to Watch For

One of the most commonly cited advantages of Pilates for people with arthritis is that it is low-impact and easy on the joints. The available evidence generally supports that reputation, but with a significant caveat. Across the eight randomized trials included in one meta-analysis, none reported adverse events linked to Pilates. However, only two of those studies, involving a total of just 18 Pilates participants, actually stated that adverse events were being actively monitored during the intervention and follow-up periods.¹ The remaining studies simply did not mention whether they tracked adverse events at all.

The difference between “no one reported getting hurt” and “we carefully checked and no one got hurt” is significant. It means the safety profile of Pilates for OA patients is probably favorable, but the research community has not established that with the rigor it deserves. As a practical matter, most exercise physiologists and physical therapists consider Pilates to be among the safer forms of exercise for people with arthritic joints, because it avoids high-impact loading, uses controlled movements, and can be easily modified. But “generally safe” does not mean “safe for everyone in every format.”

A few situations warrant extra caution:

Acute flare-ups: When a joint is hot, swollen, and significantly more painful than usual, pushing through an exercise session can increase inflammation. It is better to rest during a flare and return to Pilates once the flare settles.
Deep knee flexion: Some Pilates exercises involve deep squatting or fully bent knee positions that place high compressive loads on the joint. If full knee bending causes sharp pain, modifications like limiting the range of the movement or using props for support are reasonable adjustments.
Group class pacing: A general Pilates class moves at a set tempo and may include exercises that are not appropriate for someone with significant joint limitations. An instructor who is unaware of your condition cannot modify on the fly. Telling your instructor beforehand is a minimum; working with someone who has experience with arthritic clients is better.
Spinal OA: Nearly all the controlled trial evidence is on knee osteoarthritis. If your arthritis primarily affects the spine, some Pilates movements that involve spinal flexion, extension, or rotation under load could aggravate symptoms. The research has not validated Pilates specifically for spinal OA in the same way.

Why the Evidence Is Still Thin

If you have read this far, you have probably noticed a recurring theme: the studies are small, and the quality of evidence is often rated as low. That is not a knock on Pilates specifically. It is a reflection of how hard it is to run high-quality exercise trials. You cannot give someone a placebo Pilates class and expect them not to notice. Blinding, the gold standard that prevents participants from knowing which group they are in, is essentially impossible in exercise research, and both meta-analyses flagged this as a major source of bias across the trials they analyzed.¹

The total number of participants across all included trials was also modest. One meta-analysis drew from 322 participants total, the other from partially overlapping but similarly sized pools. For context, drug trials for osteoarthritis medications routinely enroll thousands. Exercise studies rarely attract that kind of funding, which means they remain underpowered to detect anything smaller than a large effect.

What this means for you as a reader is that the direction of the evidence is encouraging and consistent, but the precision is not great. Pilates clearly helps more than doing nothing. It probably helps about as much as other exercise. It might have a special advantage for range of motion and balance. But the “might” in that last sentence reflects a genuine gap in knowledge, not a polite hedge.

What Pilates Cannot Do for Your Joints

Osteoarthritis involves the progressive breakdown of cartilage within a joint, along with changes to the underlying bone, the joint lining, and the surrounding muscles and ligaments. No exercise program, Pilates or otherwise, has been shown to regenerate cartilage that has already worn away. The benefits documented in the research are symptomatic: less pain, better function, greater range of motion, improved quality of life. These are meaningful and genuinely change daily experience, but they do not reverse the structural changes inside the joint.

None of the available Pilates studies have tracked biomarkers of cartilage health or used imaging to assess whether the joint itself changed structurally. The outcomes measured are all patient-reported (how much does it hurt, how well can you function) or performance-based (how fast can you walk, how far can you reach). Those are the outcomes that matter most for daily life, but anyone hoping that Pilates will repair their knee should adjust that expectation. Exercise manages osteoarthritis. It does not cure it.

Mat Pilates Versus Equipment-Based Pilates

Most of the clinical trials in the OA literature used mat Pilates, which requires nothing beyond a mat and sometimes small props like resistance bands or foam rollers. The trial that showed dramatic improvements in pain and function in older women with knee OA, for instance, was a mat-based program.³ This is worth knowing because equipment-based Pilates, using a reformer or Cadillac machine, tends to be significantly more expensive and less accessible.

Equipment-based Pilates does have some theoretical advantages for people with arthritis. The reformer, with its spring-loaded carriage, allows exercises to be performed in a lying or semi-reclined position, reducing the body-weight load on painful joints. The springs provide adjustable resistance, letting you start very light and progress gradually. For someone with severe knee OA who finds it painful to get up and down from the floor, a reformer might be more comfortable than mat work.

But the research has not directly compared the two formats in OA populations. Given that mat Pilates produced clear benefits in the trials we have, it is reasonable to start there, especially if cost or access is a concern. You can always add reformer sessions later if you enjoy the method and want more variety.

How Often and How Long

The trial protocols in the available research varied, but most programs involved sessions two to three times per week over a period of six to twelve weeks. The older women’s trial that reported the largest functional improvements used a structured program of mat Pilates sessions.³ This aligns with general exercise guidelines for OA management, which recommend regular, moderate activity rather than occasional intense bouts.

One practical reality is that adherence drops off once a study ends and participants no longer have appointments to keep. Pilates has a potential advantage here because many people genuinely enjoy doing it. The group class environment, the focus on body awareness, and the sense of progressive mastery can make it feel less like a medical chore and more like a chosen activity. Enjoyment is the single strongest predictor of whether someone will maintain an exercise habit long-term, and for OA management, long-term consistency matters far more than the specific exercise modality you choose.

If you are just starting, look for an instructor who has worked with clients who have joint limitations, and mention your diagnosis at the first session. Starting with individual or small-group sessions allows the instructor to learn your body’s particular sensitivities and teach you appropriate modifications. Once you know which movements feel good and which need to be adjusted, you can transition to larger group classes or even a home practice with reasonable confidence.

Osteoarthritis Beyond the Knee

Almost everything in the research literature on Pilates and OA focuses on the knee. If you have hip OA, hand OA, or spinal OA, you are working with much less direct evidence. That does not mean Pilates is a bad idea for those joints. The general exercise recommendation for all forms of OA is the same: stay active, maintain muscle strength around the affected joint, preserve range of motion, and manage pain through movement rather than avoidance.

Pilates, with its emphasis on controlled multi-joint movement and core stability, fits that philosophy well regardless of which joint is affected. But the specific movements need to be adapted. Hip OA may require modifications to exercises involving deep hip flexion or rotation under load. Hand or wrist OA might make weight-bearing through the hands, common in exercises like planks or push-up variations, uncomfortable or inadvisable. A good instructor can substitute alternative positions, and many Pilates exercises can be performed seated or lying down.

For spinal OA, the picture is more complicated. Some Pilates staples, like the “roll-up” or “swan,” involve significant spinal flexion or extension. Whether those movements help or aggravate spinal OA depends on the location and severity of the arthritis, and on whether there are additional issues like spinal stenosis or disc degeneration. If spinal OA is your primary concern, a physiotherapist who can assess your individual movement restrictions before you start is a much safer starting point than jumping into a general Pilates class.