Can You Do Pilates if You Have Osteoporosis?
- Lorraine Maxwell
- 2 hours ago
- 4 min read
Evidence-based guidance for people with osteoporosis or osteopenia from Chartered Physiotherapist and Pilates instructor Lorraine Maxwell (Updated August 2026 • 8 minute read).
If you've recently been diagnosed with osteoporosis or osteopenia, you may wondering whether it is still safe to exercise - or whether Pilates is right for you.
For many people, the diagnosis creates uncertainty. Some become worried about bending, lifting or even exercising at all.
Fortunately, the advice has changed considerably over the last few years.
My approach is based on the Strong, Steady and Straight UK Consensus Statement on Physical Activity and Exercise for Osteoporosis (2022), which remains consistent with the latest National Osteoporosis Guideline Group (NOGG) guidance. The aim was simple: to provide clear, evidence-based guidance that would help people exercise safely while maintaining bone health, strength and independence.
One of the messages I like most is that the authors encourage people with osteoporosis to do more rather than less. Rather than avoiding movement through fear, they recommend the right type of exercise, performed appropriately, because the overall benefits far outweigh the potential risks for most people.
What does the consensus statement recommend?
The guidance highlights four key areas of exercise.
1. Progressive resistance training
Strong muscles help support strong bones.
The guidance recommends progressive resistance exercise two or three times each week, gradually increasing the load as strength improves. This might include weights, resistance bands or bodyweight exercises, depending on the individual.
2. Weight-bearing and impact exercise
Bones respond to being loaded.
For many people with osteoporosis, activities such as brisk walking, stair climbing or appropriately prescribed impact exercise can help maintain bone strength. The level of impact should always be appropriate to the individual, particularly if vertebral fractures have already occurred.
3. Balance training
Many osteoporotic fractures happen because of falls rather than because bones simply become weak.
Improving balance, leg strength and confidence can significantly reduce falls risk and is one of the key recommendations within the consensus statement.
4. Posture and spinal extension
Maintaining good posture and strengthening the muscles that support an upright spine are strongly encouraged.
The guidance recommends spinal extension exercises to improve posture and potentially reduce falls and vertebral fracture risk, while advising that people with osteoporosis avoid exercises involving a high degree of spinal flexion, particularly under load.
So where does Pilates fit when it comes to osteoporosis?
This is where things become more nuanced.
Pilates can be an excellent form of exercise for people with osteoporosis. Many of its principles closely match the recommendations within the consensus statement. Pilates can improve posture, balance, muscle strength, movement confidence and body awareness—all of which are important for healthy ageing.
However, not every Pilates class is designed with osteoporosis in mind.
A traditional mat Pilates class may include repeated roll downs, curl ups, rolling exercises or deep forward bending. These movements may be perfectly appropriate for many people, but they may not be suitable for someone with osteoporosis affecting the spine unless they have been appropriately modified.
For me, this doesn't mean that Pilates should be avoided. It means that the programme should be adapted to the individual and delivered by someone who understands the condition and current evidence.
My approach
As both a Chartered Physiotherapist and Pilates instructor, I use the Strong, Steady and Straight guidance to help shape my thinking when teaching clients with osteoporosis or osteopenia.
That doesn't mean every exercise is the same for every client. It means considering bone health alongside posture, strength, balance, confidence and previous fracture history before deciding which exercises are most appropriate.
Standing Pilates, progressive strengthening, balance work and carefully selected mat exercises can all play an important role.
My aim is never to wrap people in cotton wool.
It's to help them move with confidence, become stronger and continue enjoying the activities they love for as long as possible.
The bottom line
An osteoporosis diagnosis should never be seen as a reason to stop exercising.
In fact, the latest evidence suggests the opposite.
The right exercise programme can improve strength, balance, posture and confidence while helping to reduce falls risk and support long-term bone health.
Pilates can absolutely be part of that programme—but, as with any form of exercise, it should be appropriate for the individual and informed by current evidence.
If you'd like help choosing the most appropriate class for your needs, I'd be delighted to help.
Take the next step
Whether you're looking for studio classes or prefer to exercise at home, you'll find evidence-informed Pilates designed to help you move with confidence.
This article is intended for general information only and should not replace individual medical advice. If you have osteoporosis, osteopenia, previous fractures or other health conditions, your exercise programme should be tailored to your individual circumstances.
References
Giangregorio LM, McArthur C, Papaioannou A, et al. Strong, Steady and Straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine. 2022;56(15):837–846.
Gregson CL, Compston J, Cooper C, et al. The 2024 UK Clinical Guideline for the Prevention and Treatment of Osteoporosis (NOGG). National Osteoporosis Guideline Group. Updated 2024.
Royal Osteoporosis Society. Exercise and physical activity for osteoporosis. Available at: https://theros.org.uk (Accessed August 2026).
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