Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm


Introduction and hypothesis

The objective was to describe the intra-abdominal pressures (IAP) generated during Pilates Mat and Reformer activities, and determine whether these activities generate IAP above a sit-to-stand threshold.


Twenty healthy women with no symptomatic vaginal bulge, median age 43 (range 22–59 years), completed Pilates Mat and Reformer exercise routines each consisting of 11 exercises. IAP was collected by an intra-vaginal pressure transducer, transmitted wirelessly to a base station, and analyzed for maximal and area under the curve (AUC) IAP.


There were no statistically significant differences in the mean maximal IAP between sit-to-stand and any of the Mat or Reformer exercises in the study population. Six to twenty-five percent of participants exceeded their individual mean maximal IAP sit-to-stand thresholds for 10 of the 22 exercises. When measuring AUC from 0 cm H2O, half the exercises exceeded the mean AUC of sit-to-stand, but only Pilates Reformer and Mat roll-ups exceeded the mean AUC of sit-to-stand when calculated from a threshold of 40 cm H2O (consistent with, for example, walking).


Our results support recommending this series of introductory Pilates exercises, including five Mat exercises and six Reformer exercises to women desiring a low IAP exercise routine. More research is needed to determine the long-term effects of Pilates exercise on post-surgical exercise rehabilitation and pelvic floor health.

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We would like to thank Pinnacle Performance for their use of the facility and equipment. We would also like to thank Sarah Holdsworth and Shauna North for their assistance in conducting the exercise protocol and Johanna de Gennaro for her help building the sensors that were used in this study.


The project described was supported by grant number R01HD061787-01 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Its content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflicts of interest


Authors’ contributions

Tanner J. Coleman: project development, exercise protocol development, data collection, data analysis, data interpretation, manuscript writing; Ingrid E. Nygaard: project development, data interpretation, manuscript writing/editing; Dannielle N. Holder: project development, exercise protocol development, data collection, manuscript editing; Marlene J. Egger: data analysis, manuscript editing; Robert Hitchcock: project development, manuscript editing.

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Correspondence to Ingrid E. Nygaard.

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Coleman, T.J., Nygaard, I.E., Holder, D.N. et al. Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm. Int Urogynecol J 26, 1123–1130 (2015).

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  • Activity restrictions
  • Intra-abdominal pressure
  • Pelvic floor disorder
  • Pilates
  • Post-surgical exercise