Arthritis and exercise have a complicated relationship in most people’s minds. The joint hurts, so moving it seems unwise; not moving it makes it stiffer and weaker, which makes it hurt more. Clinical guidelines for both osteoarthritis and rheumatoid arthritis are unambiguous that appropriate exercise is a core part of management, not an optional extra — but “appropriate” is doing a lot of work in that sentence. So, is Pilates good for arthritis? Yes, and it’s one of the best-suited forms of exercise there is, provided it’s modified for your joints, your type of arthritis, and whether today is a flare day. This guide explains how.
Key takeaway: Pilates is good for arthritis because it strengthens the muscles that support and unload painful joints, keeps joints moving through a comfortable range, and is low impact and easy to modify. Osteoarthritis responds to steady strengthening; rheumatoid arthritis needs a flare-day and non-flare-day approach. Avoid deep loaded knee bends, kneeling on painful knees, and anything that makes the joint worse two hours later.
Pilates is good for arthritis because it strengthens the muscles around affected joints — which reduces the load the joint itself has to take — while moving those joints through a controlled, comfortable range without impact. For osteoarthritis of the knee and hip, this matches what clinical guidelines recommend: progressive low-impact strengthening plus mobility. For rheumatoid arthritis, Pilates works well on non-flare days, with gentle range-of-motion only during flares and no weight-bearing through inflamed hands or wrists. Modifications include reducing depth, using a chair or wall for support, and avoiding kneeling. Sophie Mercer, PMA-certified clinical Pilates instructor, designed an 8-week Over-60 protocol of 28 exercises using supported, joint-sparing movement suitable for arthritic knees, hips and shoulders.
Osteoarthritis vs rheumatoid arthritis: why it changes the plan
Osteoarthritis (OA) is mechanical: cartilage thins, the joint stiffens, and the muscles around it weaken through disuse, which loads the joint further. The exercise prescription is steady, progressive strengthening and mobility. The joint often feels better with movement, and stiffness after rest is the main complaint. Pain that’s a bit worse during exercise but settles within a couple of hours is acceptable; pain that’s worse the next day means you did too much.
Rheumatoid arthritis (RA) is inflammatory and systemic. Joints — often the small joints of the hands, wrists and feet as well as knees and shoulders — become hot, swollen and painful during flares, and fatigue is part of the disease. The exercise prescription has two settings:
- Flare days: gentle range-of-motion movement only, no strengthening of the inflamed joints, shorter sessions, and rest without guilt.
- Non-flare days: strengthening and mobility much as for OA, with extra protection for small joints — no weight-bearing through the hands, no gripping heavy props, longer warm-ups.
If you’re not sure which you have, or your joints are hot and swollen, see your doctor before starting; and tell your rheumatology team what exercise you’re doing.
What exercises should I avoid with arthritis?
- High-impact activity — jumping, running on hard surfaces — on arthritic knees and hips
- Deep loaded knee bends — full squats, deep lunges — that take an arthritic knee past its comfortable range under load
- Kneeling directly on painful knees — use a folded towel, or do the exercise standing or seated
- Weight-bearing through inflamed wrists and hands — planks and four-point kneeling during RA flares; use forearms or a wall instead
- Sustained end-range holds in inflamed joints
- Anything that leaves the joint markedly more painful two hours later — the two-hour rule is the most useful guide you have
Joint-sparing Pilates exercises for arthritis
These eight exercises strengthen the muscles that matter without loading the joints past their comfortable range. Work within a pain-free arc; a smaller range done well is the goal.
- Seated knee extension — Sit tall, straighten one knee until the leg is level, hold two seconds, lower slowly. 8–10 per side. Feel: the front of the thigh — the quad strength that unloads an arthritic knee. Avoid: locking the knee hard at the top.
- Sit-to-stand to a high chair — Use a high seat or cushions to limit knee bend. Stand without hands, lower for three. 6–10 reps. Reduce seat height as it gets easier.
- Supported partial squat — Hands on a wall or chair back, bend the knees only as far as comfortable (often 30–45 degrees). 8–10 reps. Never past the pain-free range.
- Supine bridge — Lie on your back, knees bent, lift the hips as one piece and lower slowly. 8–10 reps. Feel: glutes and hamstrings, which support both hips and knees. Place a cushion under the knees if the bend is uncomfortable.
- Side-lying leg lift — Lie on your side, lift the top leg with the toes forward, lower slowly. 8–10 per side. Builds the outer hip that stabilises the pelvis and reduces knee load when walking.
- Clam — Side-lying, knees bent, heels together, open the top knee like a clam shell without rolling the pelvis back. 10–12 per side. Feel: deep in the hip.
- Standing heel raises — Fingertips on a wall, rise and lower slowly. 10–12 reps. Calf strength supports the knee and ankle.
- Wall angels — Back against a wall, arms sliding up and down. 8–10 reps. For arthritic shoulders, work only within a comfortable range; for RA, keep the hands relaxed rather than pressing.
For hip-specific work see exercises for hip pain; for knees, the knee replacement exercises guide covers the same quad-and-glute logic before and after surgery. Seated options for very painful days are in chair Pilates exercises.
Which is better for arthritis, Pilates or yoga?
Both are low impact and both improve stiffness and strength. In practice I find Pilates suits arthritic knees and hips better, because its focus on strengthening the muscles that support a joint addresses the underlying problem, and because every exercise can be shrunk to a pain-free range without losing its point. Yoga’s long holds at end range — deep lunges, kneeling poses, weight through the wrists — are exactly the positions that provoke arthritic joints and need the most editing. The honest answer is whichever you’ll do consistently without flares; if you choose yoga, edit it as hard as you’d edit Pilates.
The downsides, honestly
Pilates doesn’t give you cardiovascular exercise, so you still need walking, cycling or swimming. Generic classes may include kneeling, deep bends and wrist loading, and move too fast to modify. And progress is slow — weeks, not days — which tests patience when a joint hurts. None of these is a reason not to do it; they’re reasons to do it in a modified, structured way.
See a clinician if a joint becomes suddenly hot, red and swollen, if you develop fever with joint pain, if a joint locks or gives way, or if pain wakes you at night and doesn’t ease with position changes.
How the Over-60 protocol helps
Sophie’s 8-Week Over-60 Program is written for exactly the joints arthritis affects: 28 exercises that use chair and wall support, work within comfortable ranges, avoid kneeling on the knees and loading the wrists, and progress strength around the hips, knees and shoulders steadily. If you’re facing or recovering from surgery, the 12-Week Knee Replacement Recovery Program and 12-Week Hip Replacement Recovery Program follow the same joint-sparing principles in a rehabilitation structure — see Pilates after hip replacement for how that works.
This article is for informational purposes only and does not constitute medical advice. Arthritis varies greatly between individuals; if you have rheumatoid arthritis, a hot or swollen joint, a recent joint replacement, or pain that worsens with exercise, please consult a doctor, rheumatologist or physiotherapist before starting or continuing an exercise programme.