Full disclosure– I am clinically trained in Reformer Pilates. I have trained with Polestar and am fully certified with APPI. I no longer teach these sessions. I still love the full studio equipment, and I know the benefits.

I was a bit confused when another of my clients who is recovering from cancer surgery and just finished chemotherapy told me they had been to a reformer studio and the session was choreographed to music. As this was the 2nd client to try it, I thought I would have a look.

Reformer Pilates has exploded in the UK, and honestly, I’m thrilled that people are discovering what this fabulous method can do. But there’s a side to the boom that worries me a little. The words “Pilates” and “Reformer Pilates” carry a lot of weight. They’re used in clinical rehab, chronic pain work, mobility training and so much more. Clients walk into any studio believing those words mean a certain standard of training and safety.

Except… they don’t. Not anymore.

Because Pilates isn’t trademarked, anyone can use the name. And with the rise of fast-track branded trainings, there’s now a huge range of instructor backgrounds in the market– from highly specialised clinical practitioners to people who’ve had a single weekend course and a bit of choreography training.

Clinical Reformer Pilates: the gold standard in rehab

This is the standard used in hospitals, alongside physio, and in specialist clinics and studios. Instructors will usually have level 3 or 4 qualifications, advanced anatomy knowledge, and training in 1 or more; pathologies, injuries, cancer and surgical considerations. They may have specialised training in scar tissue, osteoporosis, joint replacements, cancer treatment side effects, neuropathy, back pain– the list goes on.

The movements are slow, precise, controlled, and backed by clinical reasoning. This is the world I work in, and it’s highly personalised

“A Pilates Practitioner doesn’t teach a routine. They read the body in front of them and select the right tool from a deep toolkit of movement, knowledge and clinical understanding.”

Fitness Reformer Pilates: brilliant but different

These classes are structured, fun, energising, and perfect for people who are fit, well, and wanting to build strength. Many of these instructors are very good at what they do. But their training might not cover injuries, surgical histories, cancer rehab, or chronic conditions. These classes aren’t designed for people with complex needs.

There is nothing wrong with fitness reformer – it is fantastic – as long as clients understand what they are choosing.

 “A good Pilates teacher reads your body like a map. A choreographed instructor reads the playlist. Both have their place, but they are not the same job.”

Branded methods (like Bounce)) Bed or similar): faster, fun and choreographed

This is where things get muddier. Some branded reformer-style methods offer short trainings that focus on choreography and energy rather than clinical depth. They often look and feel more like a workout class on a machine

“Pilates is about understanding bodies. Choreographed fitness is about understanding beats.”

There’s absolutely space for these classes. They are engaging, accessible, and brilliant for fitness. But when a brand uses the word “Reformer Pilates,” the public often assumes a level of anatomical and clinical training that isn’t actually required for that qualification.

Why it Matters

For healthy clients? It probably doesn’t.

If you are an older adult, dealing with joint replacements, post-cancer surgery, side effects from chemotherapy, spinal issues, balance problems, lymphoedema risk, you need someone who understands the why behind the movement, not just the choreography.

A level 2 or quick-brand qualification teaches someone how to deliver a class, but not how to support your body.

A level 4 or 5 teacher understands adaptations, red flags, tissue healing timelines, cancer-related fatigue, neuropathy, lymphatic load, bone health and more.

This isn’t about snobbery. It’s about safety and results

So What Should Clients Look for?

I have a simple guide below. but really, just ask this: ask about the instructor’s background, not just the brand they represent. If you need clinical support, choose someone trained to work clinically. This goes for every kind of exercise you want to do.

Clear information empowers safer choices.

What Do Qualification Levels Mean in the UK?

Most people walk into a class because they like the teacher, the time, or it looks fun. Fair enough. But when it comes to older adults, anyone recovering from cancer or surgery, and those managing long-term conditions, the qualifications behind the person leading that class genuinely matter.

And here’s the shocker… not one of my clients realised that there are levels of qualification in the UK. Levels that determine how much training someone has had, what they can safely teach, and whether they’re equipped to support people with real bodies, real injuries and real health challenges.

So let’s break it down, simply.

   • Level 2

   • Entry- Level fitness instructor • Basic anatomy and how to lead safe, general exercise • Often the minimum for sessions like circuits, exercise to music or HIIT • Does not qualify someone to work with special populations, conditions 

   • Level 3

   • This is where you will usually find a proper pilates training usually starts • Much deeper anatomy, posture and movement knowledge • Will know how to adapt exercises safely • A safer choice for beginners or anyone with mild limitations • GP referral schemes from this level • Some conditions covered, but not medically complex ones

   • Level 4

   • Advanced clinical knowledge • Advanced trainings to work with specialist populations, Older adults, Osteoporosis, Cancer Rehab, Low Back Pain, Cardiac Rehab, Neurological conditions. There are many more. • Covers pathologies, injury management, post-surgical considerations, chronic conditions • Used in specialist rehab settings

   • Level 5 

   • Advanced clinical reasoning • Often used in medical and therapeutic environments

Many of the branded courses sit outside of these qualification levels altogether, and even within a discipline you will find one modality can require 200 – 500 hours training. That’s a huge difference in learning time!

So What should You Look For? And What Should You Ask?

1) What is your level of qualification?

2) Do you have training in working with (ask about the things that concern you)?

3) Are you insured to work with people post-surgery or with cancer?

4) How long was your training?

5) Have you done additional clinical or therapeutic training?

6) Do you screen your clients before their first session? (a well trained instructor will and clinically trained always do)

None of the questions are rude or awkward. You are protecting your body and it deserves the right level of care– a well trained instructor will welcome your questions. If someone gets defensive or vague, that’s a sign to step away.

Governing Bodies, and places to source information

CIMSPA- Chartered institute for the management of sport and physical activity – oversee profressional standards here in the UK fitness industry

STOTT, APPI, POLESTAR, BASI are all Pilates training schools with rigorous standards but not regulated regulated qualifications

Exercise Referral Standards (level 3 and 4) through YMCA Awrds and Active IQ

There are different Complementary Health bodies that support therapuetic standards for things like massage, reflexology

Ofqual Regulated Qualifications Framework – you can find guidance about training here

Pilates Method Alliance research summaries