Pilates, Bone Health, and the UK Reality: A Critical Response to Women's Health's Reformer Pilates Article

Published: August 2025 | By Mbodies Training Academy

In July 2025, Women's Health UK published an article titled “Reformer Pilates is more effective than mat for preventing osteoporosis, experts say – here's how.”   The piece, while clearly a positive endorsement of Pilates, raises serious concerns when viewed through the lens of the UK’s public health landscape and the realities facing Pilates instructors and their clients in Britain today.

At first glance, the article seems like great publicity for the Pilates industry: praising its popularity, physical and mental benefits, and growing studio presence.  However, on closer inspection, it's evident the piece has been adapted from a U.S.-centric original, with only superficial references to the UK context.  Unfortunately, this results in some dangerous omissions and misleading implications, especially around osteoporosis awareness, diagnosis, and exercise safety.

The DEXA Divide: UK vs USA

In the U.S., awareness campaigns by pharmaceutical and nutrition companies have helped normalise bone density screenings (DEXA scans) for menopausal and postmenopausal women: especially among those who can afford boutique wellness options like Reformer Pilates.

In contrast, the UK lacks proactive DEXA screening policies.  Under NHS guidance, women typically only receive a DEXA scan after sustaining a fall and often after two or more fractures. By this point, the damage is done.  Many women are unaware they have osteopenia or osteoporosis until they experience a life-altering break.

So, while U.S. Pilates instructors may reasonably tailor classes only for clients with a known diagnosis, UK instructors cannot assume the same.  Research shows that over 40% of women over 50 in the UK have low bone density without knowing it, and 1 in 2 women over 50 will suffer a fracture due to osteoporosis.  The approach of waiting for a diagnosis before modifying Pilates is not only flawed but potentially harmful.

Reformer vs Mat: A Misleading Binary

The article frames Reformer Pilates as more effective than Pilates Matwork for bone health. While it's true that resistance and upright positioning on the Reformer can offer greater weight-bearing potential, the statement oversimplifies a much more nuanced issue.

Yes, some Matwork especially supine exercises, lacks the loading stimulus needed for bone density improvement.  However, Matwork can be adapted: standing squats, push-ups, planks, and other weight-bearing and impact-enhanced variations (e.g. standing series with resistance bands or small weights) offer substantial bone-building potential when taught with bone health in mind.

What the article completely omits is that both Reformer and Mat-based Pilates carry risks for clients with compromised bone health, particularly because:

• Loaded spinal flexion
• Rotational exercises
• End-range extension
• Unsupported inversions

…are all commonly taught in Pilates but are contraindicated for clients with osteoporosis or osteopenia.

Without prior screening or training, instructors may inadvertently increase the risk of vertebral fractures in clients with undiagnosed bone fragility.  Again, this is especially concerning in the UK, where underdiagnosis is rampant.

Instructor Education Gaps: The Industry’s Blind Spot

The article gives a voice to experienced and well-intentioned instructors, but it ignores a widespread issue: the average Pilates instructor in the UK is not taught how to adapt for clients with bone density loss.  Nor are they taught a comprehensive range of Standing Exercises using the Pilates method, or a range of Accessory based exercises to adapt Pilates Matwork or standing exercises to the benefit of the Bone Health needy.

Classical Pilates and Contemporary Pilates Matwork teacher training courses routinely fail to cover osteoporosis adaptations or even red flag movements.  As a result, thousands of instructors across the UK are teaching Mat and indeed Reformer Pilates with no awareness of how to protect bone-compromised clients: many of whom are undiagnosed and over 50.

This is not just a theoretical risk; it is a daily occurrence in UK studios.

A Better Way Forward: Education and Adaptation

At Mbodies, we’ve long recognised the need for Pilates instructors to receive real, evidence-based education on working safely and effectively with clients at risk of osteoporosis.  And for over a decade we have been offering our CPD Module – available now as In your own time Online learning titled: "Understanding Osteoporosis and Bone Health Programming"

We are proud to announce that, launching in Autumn 2025, Mbodies will release three new CPD modules that directly address the critical gaps highlighted above:

Joseph Pilates 34 Exercises CPD (Matwork Focus)

A practical and essential education module for instructors working with clients over 50.  In this module, we revisit Joseph Pilates’ original 34 mat exercises (or 37, when including the historically overlooked trio), and we:

• Classify each movement as Bone Positive, Bone Neutral, or Bone Negative
• Provide safe, effective adaptations for those that are contraindicated
• Discuss evidence-based strategies for safely improving posture, strength, balance, and bone loading

This course is suitable for classical and contemporary instructors alike, and it’s vital for anyone teaching group matwork to mixed populations.

Standing Pilates (100+ Functional Exercises)

This course provides over 100 expertly selected standing Pilates exercises, designed with modern clients’ needs and functional movement patterns in mind. These movements are not only bone-friendly (by promoting upright, weight-bearing loading), but also highly applicable to balance, posture, coordination, and fall-prevention—making them ideal for clients over 50 or those managing osteoporosis or osteopenia.

Whether used as stand-alone sequences or integrated into full mat sessions, these standing exercises add dynamic variety, increased challenge, and greater real-life transfer to your programming.

Accessory-Enhanced Contemporary Matwork (60+ Adaptations)

This complementary module dives into over 60 adaptations of classical and contemporary Pilates repertoire, using popular small props and fitness tools such as:

• Resistance Bands
• Pilates Circles
• Foam Rollers
• Overballs
• Light Handweights
• Swiss Balls, and more

Each variation is carefully curated to offer progressive challenge, increased sensory input, and targeted bone-loading stimulus, without straying from the core principles of Pilates. These prop-based exercises are also a brilliant way to scale or adapt movements for clients of varying levels, injuries, or goals.

Together, these modules unlock a vast toolbox for instructors seeking to:

• Make Pilates Matwork more engaging and bone-smart
• Cater to older or higher-risk populations
• Offer progressive, evidence-based programming
• Stay creative, current, and confident in their teaching

These are not “add-ons”, they are powerful programming solutions rooted in functionality, safety, and modern Pilates evolution.   Whilst they are perfect CPD for existing Instructors they are also embedded into the Basic Mbodies Curriculum for New Pilates Instructors gaining their entry level Pilates Instructor qualifications.

Closing Thoughts: From Pilates Princess to Pilates Professional

Pilates continues to offer profound benefits for posture, balance, confidence, and emotional wellbeing. These are not to be dismissed. But as the population ages and fracture rates climb, instructors have a professional duty of care to teach responsibly.

Women's Health UK rightly celebrates the Reformer.  But it wrongly assumes that bone health knowledge is universal, and that Reformer Pilates alone is a protective measure.  In truth, only education, vigilance, and thoughtful program design can achieve this.

At Mbodies, we invite all instructors: new or experienced, mat-based or equipment-based, to upgrade your knowledge, deepen your confidence, and protect your clients.

Let’s move beyond the marketing soundbites. Let’s move safely.  Let’s move intelligently.  Let’s move forward.

📌 For more information on our CPD offerings launching Autumn 2025, visit:

www.mbodiesacademy.co.uk
Or contact us directly at info@mbodiesacademy.co.uk

Author:  Chris Onslow - Pilates Consultant

Chris Onslow, has run Pilates focussed businesses since 1998.  He and his team specialise in supporting Pilates entrepreneurs and business owners.  With a rich history of owning and running successful Pilates studios in the UK, and supporting others in Europe and the Middle East, Chris has broad expertise in maximising profitability and optimising operational efficiency.  His agency provides top-tier advice on selecting new, pre-owned, and hireable Pilates equipment from renowned brands such as Align-Pilates, Balanced Body or Stott-Pilates/Merrithew.  As the founder of Mbodies Training Academy, Chris continues to revolutionise Pilates education, offering premier online and hybrid CPD and qualification courses for Pilates apparatus instruction and special population CPD.  Discover more about how Chris can support your Pilates Business or home exercise choices:

Pilates Business Specialist Consultant

Phone: +44 (0)1993 883449

Whatsapp text +44(0)7301052846 

20 Nash Lane, Freeland, Witney, Oxon, OX29 8HS, UK

Web: https://www.pilates-consultant.co.uk/  (Pilates Consultancy, Apparatus sales and hire)

Email: chris@pilatesconsultant.co.uk

Web: https//www.mbodiesacademy.co.uk/  (Instructor training)

Email: chris@mbodiesacademy.co.uk

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