Emma Najman Bone Physio

12/06/2026

26/05/2026

21/05/2026

PILATES and bone health. Let's look at what the research actually shows.

Pilates is a great form of exercise. It builds core strength, improves posture, and supports balance. I'm not here to tell you to stop doing it. Read that twice if you need to.

But, if you have osteopenia or osteoporosis and Pilates is your primary bone health strategy, the research isn't on your side.

Bone responds to mechanical load and strain. To stimulate bone formation, your skeleton needs forces significant enough to trigger an osteogenic response. Most Pilates movements don't consistently get there.

Multiple independent reviews have looked at this question and landed in the same place.

A 2022 meta-analysis in the Journal of Geriatric Physical Therapy found that Pilates had no significant effect on lumbar spine, total hip, or femoral neck BMD in postmenopausal women. A systematic review conducted to inform Canada's 2021 Clinical Practice Guidelines for osteoporosis screened over 7,000 records, found only 5 studies that met inclusion criteria, and concluded the evidence on Pilates and BMD was insufficient and inconclusive. A broader 2021 meta-analysis in PLOS ONE pooled data from 11 studies and 591 participants and found an effect size near zero.

The pattern is consistent. Pilates doesn't move the needle on bone density. And, a personal testimony is not the highest quality evidence.

Contrast that with two studies that directly compared resistance training to Pilates-based programs:

LIFTMOR trial (Watson et al., 2017/2018) compared high-intensity resistance and impact training to a low-intensity home exercise program in postmenopausal women with low bone mass.

The high-intensity group showed significant improvements in lumbar spine and femoral neck BMD. The low-intensity group did not.

MEDEX-OP trial put high-intensity resistance training (Onero) directly head to head with Buff Bones, a Pilates-based hybrid program designed specifically for bone health.

After 8 months of supervised sessions twice per week, the high-intensity group showed meaningful gains in lumbar spine BMD (1.9% vs. 0.1%),along with significantly greater improvements in muscle strength and functional performance.

The Pilates group produced some improvement in muscle strength, but significantly less than the resistance training group, and no meaningful effect on bone mass. This isn't a knock on Buff Bones. It's a load problem. The mechanical stimulus isn't high enough to drive significant bone adaptation.

Keep Pilates if you love it. Pair it with a progressive resistance training program designed with bone health in mind. That's where the results are.

Dr Lisa Moore, DPT

Citations in comments:

22/03/2026

🆕🗞️New overview of systematic reviews published by the American College of Sports Medicine, about resistance training for muscle size and function in healthy adults, with key conclusions in infographic. Bottom line: Train consistently with high effort. Progress the difficulty over time. If you want to get stronger, lean towards higher difficulty and lower reps. If you want to get bigger, volume of sets and a focus on eccentric loading (controlled, slower lowering of weight) may be more important. To build power, you need a balance between effort/difficulty and speed.
For the research article look here: https://pmc.ncbi.nlm.nih.gov/articles/PMC12965823/

29/09/2025

Balance becomes harder with age due to declines in the musculoskeletal system, including muscle strength and joint flexibility, and age-related changes in the nervous system, such as decreased vision and inner ear function, as well as reduced coordination between the brain and body. Other factors include medication side effects, chronic health conditions, and decreased blood flow to the brain.

Changes in the Musculoskeletal System

Decreased Muscle Strength: Age-related muscle loss (sarcopenia) weakens the muscles needed to maintain stability and stop body movements, making it harder to recover from a loss of balance.

Reduced Flexibility and Joint Mobility: A decline in flexibility can restrict the range of motion in your joints, which is crucial for stable movement and balance.

Changes in the Nervous System

Sensory Decline: Vision can become impaired, with reduced depth perception and difficulty differentiating contrasts, making it harder to navigate and identify hazards.

Inner Ear Problems: The vestibular system, located in the inner ear and responsible for detecting movement and maintaining equilibrium, can become less effective.

Brain Function: Aging can affect the brain's ability to integrate sensory information and send proper motor commands, impacting coordination and balance control.

Other Contributing Factors

Medication Side Effects: Many medications commonly used by older adults can cause dizziness, drowsiness, or a drop in blood pressure, all of which increase the risk of falls.

Chronic Conditions: Conditions like arthritis, Parkinson's disease, diabetes, and dementia can affect a person's mobility, coordination, and overall stability.

Reduced Blood Flow to the Brain: Decreased blood flow or damage to blood vessels in the brain, particularly in areas like the cerebellum and brainstem that control balance, can lead to instability.

Lifestyle: A sedentary lifestyle with limited physical activity can contribute to reduced muscle strength and flexibility, further impacting balance.

Start practicing with balance exercises today before your balance declines, putting you at risk of falls and fractures.