Multiple Sclerosis and Pilates: What Does the Research Actually Show?

Multiple sclerosis can affect walking, balance, strength, coordination and fatigue. Symptoms differ widely between people and may fluctuate from one day to the next.

Pilates has been studied as physical activity and an adjunct to rehabilitation. Results are encouraging, especially for mobility and balance, but Pilates does not treat MS itself or replace neurological care and individual rehabilitation.

Why is Pilates studied in multiple sclerosis?

Pilates combines controlled movement, trunk stability, mobility, coordination and breathing. Exercises can be performed on the mat, seated or standing, which makes them adaptable.

Research focuses on functional goals: changing position more easily, improving postural control, walking more comfortably, maintaining strength and sometimes managing fatigue.

What the latest evidence shows

A 2026 systematic review and network meta-analysis included 22 randomized trials and 901 participants. Pilates showed favourable results for functional mobility and balance. Some formats were also associated with better walking endurance, fatigue or quality of life.

Programmes, duration and comparison groups varied considerably. The authors reported risk of bias, heterogeneity and limited long-term follow-up. No comparison reached high certainty of evidence.

Balance, mobility and fatigue

Balance is among the most consistently improved outcomes. A 2022 meta-analysis found benefits on several balance and mobility measures, but did not establish that Pilates is better than other rehabilitation approaches.

Fatigue findings are less consistent. NICE states that aerobic, resistance and balance exercise, including Pilates, may help. Fatigue still requires a broader assessment because sleep, pain, spasticity, medication, infection, anxiety or depression may contribute.

How can a session be adapted?

An adapted session should reflect the person's symptoms and abilities that day. Secure supports, early rest breaks, shorter exercise blocks, natural breathing and a cool environment for heat-sensitive people may help.

A shorter or seated session is not a failed session. It may be the most appropriate choice. A relapse or new neurological symptoms require medical advice before continuing the usual programme.

Mat, equipment or home practice?

Studies have used different formats. A trial comparing mat and Reformer Pilates reported improvements in both groups without overall superiority for the equipment. Accessibility, safety, guidance and consistency matter more.

For home practice, an initial professional assessment can help select positions, supports and an appropriate level.

In summary

Current evidence suggests that Pilates may help some people with MS improve balance, functional mobility and sometimes walking or fatigue.

Results vary and certainty is not high. A gradual programme adapted to symptoms, ideally supported by a professional familiar with MS, offers the most sensible framework.