Pilates After 50: A Guide to Safe, Effective Practice as You Age
Updated: Oct 6
By Katherine, Lead Instructor, Certified Pilates Instructor
Yes, Pilates is generally a suitable form of exercise for people over 50 and for older adults, as long as it is adapted to your health, strength and balance. A meta-analytical review of 51 trials in older adults (average age 66.5) found moderate gains in a combined set of physical outcomes compared with no exercise, but smaller gains compared with other exercise (Meikis et al., 2021).
Key takeaways
A review of 51 trials (2,485 adults, average age 66.5) found Pilates improved physical and psychological outcomes versus no exercise, with smaller and less certain differences versus other active exercise (Meikis et al., 2021).
Pilates can build strength and balance, but Canadian guidance for older adults also calls for regular strength training and balance-challenging activity, so Pilates works best as part of a wider routine.
The evidence for balance is mixed, and no high-quality evidence shows Pilates reduces actual falls.
If you have osteoporosis, joint pain, a joint replacement, or a history of falls, your program should be adapted and discussed with your health care provider first.
It is rarely too late to start. Most trials involved people in their sixties, so evidence in people in their eighties is thinner, and individual adaptation matters more.
Is Pilates good for people over 50?
For most healthy people over 50, yes. The strongest single source is a 2021 meta-analytical review of 51 randomized controlled trials involving 2,485 older adults (each study sample averaged over 55 years; overall average age 66.5). Compared with no exercise, Pilates produced moderate improvements in a combined group of physical outcomes (muscle strength, balance, endurance, flexibility, gait and physical functioning), and the size of the effect was similar in healthy adults and in adults with clinical conditions such as back pain, diabetes or Parkinson's disease (Meikis et al., 2021).
The same review also pooled psychological outcomes (including quality of life, depression, sleep quality, fear of falling and pain) and found moderate to large improvements compared with no exercise. Two caveats matter. First, when Pilates was compared with other forms of active exercise, the physical benefit was small to moderate and the psychological difference was not significant. In other words, Pilates helps relative to doing nothing, and it performs about as well as other reasonable exercise. Second, the authors describe substantial variation between the included trials in session length, frequency, measurement tools and populations, which limits how firmly anyone can recommend a specific dose.
None of the included studies reported adverse events. That is encouraging, but it does not prove no one is ever hurt, and the trials were supervised. A systematic review of nine trials of mat Pilates in healthy adults over 60 (people with no recorded health concerns), summarized by the UK's National Institute for Health and Care Research, concluded it is safe in this group when taught by a qualified instructor and tailored to individual ability, while noting limits to the reliability of the evidence (NIHR Evidence summary of Bueno de Souza et al., 2018). It does not tell us about people with osteoporosis, joint replacements or falls.
What Canada's movement guidelines recommend as you age
Canada's 24-Hour Movement Guidelines for adults 65 and older recommend at least 150 minutes of moderate to vigorous aerobic activity a week, muscle-strengthening activity using the major muscle groups at least twice a week, and activities that challenge balance, alongside good sleep and less sitting. They also say that progressing towards these targets brings health benefits, so you do not need to meet every number on day one (Canadian Society for Exercise Physiology, 2020). Adults living with a disability or medical condition are advised to speak with a health professional.
Pilates is not a complete answer to all of those targets, because it is not designed to raise your heart rate the way brisk walking or swimming do. It can contribute to the strength and balance part, with an instructor adjusting the work to you.
Can Pilates help with strength and muscle as you get older?
Resistance training has some of the strongest evidence of any exercise type for older adults. A Cochrane review of 121 trials with 6,700 older adults found that progressive resistance training (exercise two to three times a week against a gradually increasing load) had a large positive effect on muscle strength, a moderate to large improvement in getting out of a chair and a modest improvement in walking speed. Serious adverse events were rare, though the authors urged caution because they were not always well reported (Liu and Latham, 2009).
Pilates research in older adults points in the same direction, with less certainty. The mat Pilates review above reported a large improvement in lower limb strength compared with no exercise, though five of the nine trials were rated high quality and four low, and most staff knew which group participants were in, which can bias results in favour of the intervention (NIHR Evidence summary of Bueno de Souza et al., 2018).
What this means in practice:
Pilates is a legitimate way to build and maintain strength, with the clearest evidence for leg strength.
Strength gains depend on progressive loading. Reformer springs make it easy to adjust resistance gradually, while mat work relies mainly on body weight, so mat-only programs may need extra loading elsewhere. Our guide to reformer versus mat Pilates explains the difference.
If your goal is strength, it is reasonable to combine Pilates with heavier resistance work, and our comparison of Pilates and strength training looks at when you need both.
We have not found direct trials comparing Pilates alone with structured strength training in older adults, so we cannot say one replaces the other.
Does Pilates improve balance, and does it reduce falls?
Pilates can help some people with balance, but the evidence is mixed: roughly half of the balance programs in a 2023 review showed a benefit (Sampaio et al., 2023), and another review found an absence of high-quality evidence that Pilates reduces actual falls (da Silva et al., 2021).
If balance or falls are your main concern, our full guide on Pilates, balance and fall risk goes through the evidence in detail. If you have fallen, feel unsteady, or are frail, Pilates should complement a program recommended by your doctor or physiotherapist, not replace it.
Pilates and bone health after 50
There is not good evidence that Pilates raises bone density, and we do not claim that it does. When fracture risk is high, Osteoporosis Canada advises limiting repetitive bending and twisting of the spine, so exercises that involve forward bending and twisting should be modified (Osteoporosis Canada, Too Fit to Fracture). Our detailed guide to Pilates and osteoporosis covers this properly, and the safest first step is a conversation with your doctor.
Joints, arthritis and joint replacements
For knee osteoarthritis, a 2025 meta-analysis found Pilates improved pain, stiffness and function compared with no treatment but not compared with other exercise, and rated the evidence very low certainty (Zhang et al., 2025).
Pilates is a reasonable, low-impact way to keep moving with arthritic joints, not a proven treatment and not better than other exercise. Knee bend depth, joint loading and flare-up handling all need individual adjustment. If you have had or are planning a hip or knee replacement, read our guide to Pilates before and after joint replacement, and follow the timing and restrictions set by your surgeon.
What about the menopause transition?
The menopause transition often arrives around this stage of life. We cover symptoms separately in Pilates for perimenopause and menopause. The bone, strength, balance and joint advice here applies whether or not you are going through it.
Is it too late to start at 60, 70 or 80?
It is not too late. The Canadian guidelines encourage older adults to work towards their targets gradually and note that any progress brings some benefit (Canadian Society for Exercise Physiology, 2020).
There are honest limits, though. The average age in the 51-trial review was 66.5, and most Pilates research is in people in their sixties and seventies. We are not aware of strong evidence specific to people in their eighties or nineties, so the case for starting later rests on general exercise evidence and on careful adaptation, not on Pilates-specific trials at that age.
A sensible way to think about starting at different ages:
In your fifties and sixties: Most people can begin with a standard beginner pathway, adjusted for any injuries, joint pain or bone concerns. Our guide to Pilates for beginners walks through what to expect.
In your seventies: Expect a slower build and more attention to getting up and down safely, balance and fatigue.
In your eighties and beyond, or with frailty: Individual sessions, close supervision and clearance from your doctor are especially important, and Pilates should sit alongside, not instead of, any falls-prevention or rehabilitation program you have been given.
How should Pilates be adapted after 50?
In our sessions we adapt exercises to the person in front of us, and we work alongside your health care provider rather than in place of them. Common adaptations include:
Getting on and off equipment. Lying down and getting up again is itself an exercise. Positions can be changed or supports added.
Spine-sparing choices. Replacing deep forward bending and end-range twisting with hip hinging, neutral-spine strengthening and gentle extension-based work when bone health is a concern.
Range and load. Smaller ranges, lighter springs and fewer repetitions, progressing gradually.
Balance support. Using a wall, chair, reformer frame or the instructor's hand as needed while you practise standing and single-leg work, and increasing the challenge only when it feels steady.
Pain rules. Some effort and mild muscle fatigue are normal. Sharp, joint-related or radiating pain is a reason to stop and tell your instructor.
Private or group Pilates after 50?
For most people starting out after 50, especially if you have a health condition, a past injury or concerns about falling, individual sessions are a good place to begin, because your instructor can watch how you move and adjust in real time. Once you know your limits, a small group setting can add routine and variety. Our guide to private versus group Pilates goes through the trade-offs in more detail.
At Align & Flow, a Small Group Pilates Class is reformer-based with a maximum of three people, which means an instructor can still see each person.
Safety note: This article is general information, not medical advice. If you have osteoporosis or a vertebral fracture, a joint replacement, heart or blood pressure conditions, dizziness, a history of falls, or any new or unexplained symptoms, speak with your family doctor, physiotherapist or (after a joint replacement) your surgeon before starting. Stop exercising and seek medical care if you have chest pain or pressure, severe shortness of breath, fainting or near fainting, new numbness or weakness, sudden severe back pain (especially after a bend, a lift or a fall), or sharp pain in a joint. Our instructors are not physiotherapists and do not diagnose or treat medical conditions. We adapt sessions based on the information you and your health care provider share with us.
Starting Pilates after 50 in Markham
If you are new to Pilates or returning after a break, a Posture Assessment + 1:1 Pilates Intro (1 hr 15 min) is a good first step: it gives your instructor a chance to see how you move and to plan around your health history, goals and any restrictions from your doctor. For ongoing individual attention, choose Private 1:1 Pilates with Instructor (1 hr). We are a boutique, appointment-based studio in Markham, and you can book a class online.
Frequently asked questions
What should I tell my instructor before my first session?
Tell them about any surgeries, fractures or a bone density diagnosis, joint pain, past falls, dizziness, and any restrictions your doctor or physiotherapist has given you. Also share your goals, such as getting up from the floor more easily or feeling steadier on stairs, so the session can be built around them.
Do I need to be flexible or strong to start?
No. Exercises can be scaled to a low starting strength and mobility, and building those is part of the point.
Do I need to get down on the floor to do Pilates?
Not necessarily. Many exercises can be done on the reformer, seated or standing, and floor work can be built up gradually. Our reformer Pilates guide explains how the equipment works.
How long and how often were Pilates programs in studies of older adults?
In the 51-trial review, most programs ran two or three sessions a week of about 60 minutes, for an average of 12 to 14 weeks (Meikis et al., 2021). No single frequency has been shown to be best, so start where you can stay consistent, and see our weekly Pilates guide for how to choose.
Will you work with my physiotherapist?
Yes. Share any exercises or restrictions your physiotherapist has given you, and we adapt sessions around them as a complement to their care, not a replacement. Our guide to Pilates or physiotherapy explains how the two differ.
Sources
Meikis L, Wicker P, Donath L (2021). Effects of Pilates Training on Physiological and Psychological Health Parameters in Healthy Older Adults and in Older Adults With Clinical Conditions Over 55 Years: A Meta-Analytical Review. Frontiers in Neurology, 12:724218. https://doi.org/10.3389/fneur.2021.724218
Sampaio T, et al. (2023). The Effectiveness of Pilates Training Interventions on Older Adults' Balance: A Systematic Review and Meta-Analysis of RCTs. Healthcare (Basel), 11(23):3083. https://pubmed.ncbi.nlm.nih.gov/38063651/
da Silva LD, Shiel A, McIntosh C (2021). Pilates Reducing Falls Risk Factors in Healthy Older Adults: A Systematic Review and Meta-Analysis. Frontiers in Medicine, 8:708883. https://pubmed.ncbi.nlm.nih.gov/34540865/
Bueno de Souza RO, Marcon LF, Arruda ASF, Pontes Junior FL, Melo RC (2018). Effects of Mat Pilates on Physical Functional Performance of Older Adults: A Meta-analysis of Randomized Controlled Trials. American Journal of Physical Medicine & Rehabilitation, 97(6):414-425. Summarized by NIHR Evidence (2018): Mat Pilates probably improves balance and strength in older adults. https://evidence.nihr.ac.uk/alert/mat-pilates-probably-improves-balance-and-strength-in-older-adults/
Liu C-J, Latham NK (2009). Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews, CD002759. https://www.cochrane.org/evidence/CD002759.progressive-resistance-strength-training-improving-physical-function-older-adults
Canadian Society for Exercise Physiology (2020). Canadian 24-Hour Movement Guidelines for Adults 65 Years and Older. https://csepguidelines.ca/guidelines/adults-65/
Osteoporosis Canada (n.d.). Too Fit To Fracture. https://osteoporosis.ca/too-fit-to-fracture/
Zhang K, Li Y, Zhao F, et al. (2025). The efficacy and safety of Pilates exercise in patients with knee osteoarthritis: a systematic review with meta-analysis of randomized controlled trials. Annals of Medicine, 57(1):2540616. https://doi.org/10.1080/07853890.2025.2540616
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