Pilates for Healthy Aging

Sara
May 28
11 min read

Updated: 3 days ago

Getting older presents many health challenges, but we can age healthily, and a Pilates exercise practice can be an effective tool to facilitate that process.

People performing Mermaid on Pilates Reformers — Pilates using the Reformer

It’s never too early—or too late—to become physically active. Older adults (65+) gain substantial benefits from regular physical activity[1], while young adults, even in their 20s, can begin employing preventative measures for healthy aging through consistent exercise. It’s not just about adding years to your life; it’s about adding life to your years. Pilates is a fun, adaptable exercise system that benefits adults of any fitness level at any age.

Our bodies were made to move! In ancient times, people didn’t have phones or computers to sit and stare at all day, nor did they have delivery services that encourage prolonged sitting. They were constantly on the move, building shelter and seeking nutrients. Because of our desk-oriented modern lifestyle, it is recommended that all adults engage in regular physical exercise and generally move more and sit less. The Centers for Disease Control and Prevention (CDC) provides key guidelines for all adults (18+), with additional recommendations for older adults (65+), which include the following[2]:

Aerobic Exercise: Aerobic activity improves the health of your heart, lungs, and circulatory system. Adults should aim for 2½ to 5 hours per week of moderate-intensity aerobic activity or 1 hour 15 minutes to 2½ hours of vigorous aerobic activity, preferably spread throughout the week.

Muscle-Strengthening Exercise: Muscle-strengthening activities can help you stay independent and prevent fall-related injuries. Engage in moderate- to high-intensity exercises that involve all major muscle groups at least two times per week.

Balance: Good balance helps prevent falls and improves stability. In addition to aerobic and muscle-strengthening activities, include multicomponent physical exercises that incorporate balance training.

"It’s not just about adding years to your life; it’s about adding life to your years."

For example, moderate aerobic activities for older adults include walking, dancing, swimming, and some forms of Pilates. Muscle-strengthening activities might involve resistance bands, equipment such as the Pilates Reformer, hand weights, or bodyweight exercises like planks, lunges, and abdominal crunches—commonly featured in Pilates classes. Multicomponent and balance work may involve standing on one foot while rotating the upper body or performing unilateral arm or leg exercises, with or without apparatus like the Exo chair; these components are integral to a well-rounded Pilates program.

While the risk of many chronic conditions increases with age, let’s examine some common conditions associated with aging and explore how Pilates can both prevent and benefit individuals dealing with these issues.

Sarcopenia

Sarcopenia is a serious condition characterized by loss of muscle mass and function. Although it is primarily seen in the elderly, it can affect anyone. Research indicates we lose 3-5% of our muscle mass per decade starting at age 30[3]. By the age of 60, this loss accelerates, making simple daily activities— such as getting up out of a chair or opening a jar— considerably more challenging. This decrease in mobility is linked to falls, injuries, and even mortality. Additionally, hormonal changes during menopause further accelerate muscle loss in women[4].

Can we combat this? Yes! When it comes to muscle mass, it’s a case of "use it or lose it." A healthy diet combined with a consistent strength training program can increase muscle mass and strength even after some loss has occurred. In a 12-week study of menopausal women aged 59–66 who practiced Pilates twice per week, participants showed an over 8% increase in hand-grip strength, a 23% improvement in chair-to-stand performance, and nearly a 31% increase in abdominal strength—critical for balance and spinal support. Pilates has proven effective in increasing upper body, lower body, and core strength[5].

A Pilates training program designed to combat sarcopenia should include full-body strengthening exercises twice per week. Barring any additional conditions, exercises could include:

Footwork: Using the Reformer, the Exo Chair, or standing on the mat.

Bridging: On the mat, the Reformer, or the Exo Chair.

Planks: With modifications available.

Arm exercises: At the springboard or the Reformer.

Prone exercises: Such as Swimming (using a long box or mat).

Abdominals: On the mat or Supine arms in straps on the Reformer.

Pilates exercises are designed to accommodate various ability levels, and a skilled instructor will work with you to modify exercises as needed to help you succeed and progress. This can be achieved by adjusting the load for weight-bearing exercises to offer the appropriate challenge or support, allowing for optimal muscle activation and engagement of deep supporting muscles. For example, props such as a box and mat can enable you to perform planks from a kneeling position, a ballet barre can support balance during lower body exercises like squats, and balls can help support the sacrum during abdominal work while promoting proper joint alignment.

Woman doing quadruped exercise, aka bird dog — Pilates Quadruped exercises

Osteoporosis and Osteopenia

Osteoporosis is a condition characterized by low bone mass and an increased risk of fractures. Most of us reach our peak bone mass in our twenties, at which point bone tissue is replaced at roughly the same rate it is lost. However, beginning at age 30, this process becomes less efficient, and we gradually lose bone faster than it can be replaced. This initial loss of bone density is called osteopenia; when it becomes severe, it progresses to osteoporosis, where bones become brittle and the risk of fractures increases markedly. Menopause and the subsequent loss of estrogen significantly diminish the body’s ability to replace bone, which is one reason women are about four times more likely than men to suffer from osteoporosis[6]. Many people do not know they have this condition until a bone fracture occurs.

The good news is that Pilates can have a positive effect on those with osteopenia and osteoporosis. Studies show that consistent weight-bearing and resistance training can prevent or slow bone loss—and even increase bone density—regardless of age[7]. A comparative study of postmenopausal women diagnosed with osteoporosis found that those who participated in supervised Pilates twice per week for a year experienced improvements in quality of life, enhanced functionality, and reduced pain compared to women performing at-home exercises for the same period[8].

Pilates consists of exercises that focus on strengthening the core while engaging the entire body to boost overall strength and mobility. As a result, Pilates benefits those with osteoporosis in two significant ways: it helps prevent further bone loss and the subsequent vulnerability to fractures, and it enhances strength, balance, and coordination—all of which are essential in preventing falls.

Can you perform Pilates if you already have osteoporosis? Absolutely! You may have been advised to avoid forward-flexion exercises or assumed that Pilates consists only of abdominal crunches, but that is far from the truth. A good Pilates instructor will tailor a program to strengthen your core and provide a full-body workout without compromising safety through forward flexion. In Pilates, every exercise engages the core, regardless of which superficial muscles are primarily in action. Examples include:

Hinge Bridging: With a flat back.

Spinal extension exercises: E.g., Swimming, Pulling Straps Prone, Chest Expansion.

Quadruped exercises: With arm/leg extensions.

Standing abductor/adductor: Such as Leg Springs at the springboard.

Seated Arm exercises on the Reformer: E.g., Biceps curls, Side Arm, Adduction, Abduction

Feet in Straps: Can include supportive props such as the wedge.

Couple doing one-leg balance exercise — Balance exercises

Balance and Falling

One in four adults over the age of 65 will fall each year. Moreover, because osteoporosis is often undiagnosed, a fall could easily result in a bone fracture, potentially triggering serious complications—including disability or even death. For many older adults, the fear of falling becomes so severe that it disrupts daily life, causing them to avoid activities like walking, grocery shopping, or social gatherings[9]. This avoidance creates a vicious cycle, as regular activity and movement are what help maintain strength, mobility, and stability.

Sarcopenia increases the risk of falling, while osteoporosis further elevates the risk of fractures if a fall occurs. Additionally, balance and proprioception (our sense of where we are in space) tend to decline with age if not regularly practiced. It’s never too early to incorporate balance exercises into your routine. Pilates not only helps counteract sarcopenia and osteoporosis but also enhances balance, proprioception, and confidence—all of which reduce the fear of falling.

Have you ever tried to stand on one foot with your eyes closed? It’s challenging and highlights just how much we rely on vision to maintain balance. Pilates exercises work your body in all directions, increasing your awareness of how your limbs function as levers and how their weight is distributed during various movements. Unilateral Pilates exercises and core stability work promote functional strength. Consider carrying a bag of groceries while tripping over an unseen stair—the added weight shifts your center of balance. With a strong core and well-trained, unilateral leg strength, you can stabilize yourself and prevent a fall. Moreover, Pilates improves grip strength, which is crucial for securing a railing in the event of a misstep on a stair.

Great examples of Pilates exercises to strengthen proprioception and balance include:

The Hundred or Short Box series: Including variations that target the obliques.

Quadruped exercises: With opposite arm/leg extension and variations.

Standing Triceps Press with Heel Lifts (calf raises)

Single Leg Footwork: With variations that emphasize ankle articulation.

Side Lying Footwork or Foot in Strap exercises

Stability exercises: Exercises that incorporate props like the Bosu ball.

Feet in Straps on Pilates Reformer — Feet in Straps on the Reformer

Osteoarthritis

It is estimated that one in five U.S. adults has osteoarthritis, and this number increases to one in three for adults aged 65 and over—of which 62% are women[10]. Although there are many types of arthritis, osteoarthritis is the most common. This condition primarily affects the cartilage in the joints. As the cartilage wears away, the bones underneath rub together, causing pain, swelling, and reduced joint mobility. Osteoarthritis is degenerative. Symptoms vary by person but generally include joint pain in the hands, knees, feet, neck, hips, and spine, along with swelling and inflammation. In younger populations, osteoarthritis can develop as a secondary issue resulting from injury, surgery, or overuse from certain sports.

The catch-22 with osteoarthritis is that painful joints may prevent you from moving them, yet a lack of regular movement further reduces mobility and can lead to even more pain over time. The good news is that Pilates is designed for every body. The goal of Pilates for individuals with osteoarthritis is to promote and maintain long-term joint mobility without causing harm. In private sessions, a skilled Pilates instructor can identify your specific areas of concern—whether localized or throughout your body—and demonstrate how to modify exercises. These modifications allow you to enjoy the benefits of exercise pain-free and build the confidence to participate in group classes.

Pilates modifications for osteoarthritis depend on the specific location of the joint pain. It is possible to work all the muscles of the body by modifying the range of motion, resistance, or even changing the apparatus used. Pilates techniques emphasize focus, concentration, and muscle connections, often incorporating isometric contractions so that muscles can be effectively worked through a limited range of motion. Some examples include:

Osteoarthritis of the Hip:

Footwork on the Reformer or Ballet Barre: The range of motion can be reduced while still engaging the muscles of the abdominals, glutes, hamstrings, and calves.

Feet-in-Straps on the Reformer: Exercises such as Leg Circles can engage muscles while helping lubricate the hip joint through a personalized range of motion.

Osteoarthritis of the Knee:

Reformer Facing / Facing Away from Straps: Exercises that are typically performed while kneeling can be modified to be done in a seated position, reducing stress on the knees.

Side-Lying Exercises: Performed on the Reformer or a mat, these help to work the abductors, adductors; important for maintaining knee stability.

Squats at the Ballet Barre: The range of motion can be adjusted as needed to accommodate knee discomfort.

Neurological Changes

Brain health is a universal concern, yet we often overlook exercising the brain in the same deliberate way we exercise our bodies. However, because the brain is part of the body, it also benefits greatly from physical activity. Dementia is a broad term that describes the loss of cognitive functions—including memory, thinking, and reasoning—and encompasses neurological disorders such as Alzheimer’s disease. Although dementia is most commonly identified in older populations, recent studies indicate that its underlying processes may begin as early as our 20s and 30s[11]. Early intervention and consistent therapies can slow— and sometimes even reverse—cognitive decline. However, at more advanced stages, interventions may only slow its progression. If you knew this was occurring in your otherwise healthy brain, wouldn’t you take steps to stop it before it advances? The good news is that you can!

Pilates offers multiple ways to boost brain health, whether you are 20 or 70 years old. The physical component alone enhances cognitive function; in addition, Pilates incorporates coordinated movements that challenge concentration and strengthen the mind-body connection. Furthermore, breath work, mindfulness, and focus are key elements of any Pilates practice that contribute to overall brain health. A skilled Pilates instructor typically never repeats the same class twice, ensuring that you are always learning new moves, engaging your concentration, and having fun in the process.

While most Pilates exercises benefit the brain, there are specific coordination and combination moves designed to provide additional cognitive challenges. Examples include:

Footwork: Vary foot positions and incorporate arm movements.

Bow and Arrow: Perform this exercise using the Reformer or the springboard.

Supine Arms in Straps/ Coordination: Engage in exercises that require synchronized movements while using straps.

Single-Foot in Strap: Mirror movements in both legs to enhance coordination.

Bridges: Incorporate variations or props to add extra challenges.

Cardiovascular

The cardiovascular system consists of the heart and blood vessels, which transport blood throughout the body. As we age, our heart rate naturally decreases, leading to a slight reduction in the volume of blood pumped through the body. Both aerobic and resistance-training exercises have been shown to benefit heart health, particularly in preventing heart disease and stroke.

While Pilates is known for its slow, flowing movements, there are aerobic styles of Pilates classes available, including low-impact variations. Moreover, even during the slow, controlled movements of a typical Pilates session, you may find your breathing intensifies and your muscles feel worked as they call for increased blood flow. In fact, resistance training is now considered to be more beneficial to heart health than traditional “cardio” or aerobic activity, although both types of exercise are recommended[12].

Examples of cardiovascular Pilates exercises include:

Reformer Jumping: Using the jump board for dynamic movement.

Squats, Lunges and Scooters: Performed at a quicker pace with hand weights to elevate the heart rate at the ballet barre or the Reformer.

<a href="https://www.vecteezy.com/free-photos/elderly">Elderly Stock photos by Vecteezy</a>

Additional Age-Related Benefits of a Regular Pilates Practice

Menopause: In addition to addressing menopause-related sarcopenia and osteoporosis, Pilates may promote better sleep, reduce stress, and alleviate depression—common concerns during peri- and post-menopause.

Immune Function: Moderate exercise enhances immune system function and helps reduce the risk of infections.

Cancer Prevention: Regular exercise may lower the risk of eight common cancers, including those of the bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach.

High Blood Pressure: Consistent physical activity helps maintain healthy blood pressure levels.

Type 2 Diabetes: Exercise aids in regulating blood sugar levels, reducing the risk of type 2 diabetes.

Depression: Engaging in regular exercise can help mitigate symptoms of depression.

Mental and Emotional Health: Exercise not only supports physical health but also promotes emotional and mental well-being, often with the added benefit of social connection.

Pilates can benefit the aging population in a variety of ways, while also serving as a preventative measure for individuals of any age. Although the conditions mentioned here are commonly associated with aging, I can work with you to understand your unique body, along with any previous or current injuries, surgeries, medications, or disabilities, and design a tailored program to help you feel your best. Contact me to find out more about private sessions and appropriate group classes for you, and incorporate Pilates into your life today.

Sara Hill, Greater Denver Area

206-696-8882

saraskitch@gmail.com

About the Author:

Sara is passionate about health and continually researches new information to help her live her best life through proper nutrition and exercise. In her youth, she was active in gymnastics, which led to cheerleading and dance during her teenage years, and she later became a dedicated aerobics enthusiast in the 1980s and 1990s. Eventually, she enlisted a personal trainer and competed in bodybuilding, earning the title of Seattle’s “Miss Seattle Lightweight” while breaking state records in subsequent powerlifting competitions. Following an early diagnosis of arthritis, she shifted her focus away from heavy weights and moved her physical pursuits outdoors. Today, she enjoys daily 3-mile walks and hiking near her home in beautiful Colorado. Sara’s Pilates journey began in 2022 as an enthusiast; not long after, she left the corporate world to pursue Pilates full-time. She began teaching Pilates in 2025 and is currently undergoing a 500 hour certification program through Club Pilates.

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