Woman holding a plank on a Pilates reformer in a bright studio

Pilates Benefits: What the Research Supports and What It Does Not

10 min read

Pilates is a low-impact method built on controlled movement, breathing and trunk control, done on a mat or on a spring-loaded machine called a reformer. A Cochrane review described it as one of the most popular exercise programmes used in clinical practice.

Meta-analyses, which pool the results of many trials, have now tested Pilates for back pain, balance, depression and anxiety symptoms, and body weight. The results are positive in each area, but the quality of the trials is often low. Reviews disagree on whether Pilates beats other exercise for back pain, and for balance in older adults it performed about the same as other exercise.

14 points
Less back pain on a 0 to 100 scale than with minimal intervention, under 3 months
Yamato et al. 2015, Cochrane review, 6 trials, low-quality evidence
0.76
Effect size for general balance in older adults, versus control groups. An effect size is a standardised gap between groups
de Campos Junior et al. 2024, 39 studies
0.73
Effect size for lower depression symptoms in women with raised symptoms
Ju et al. 2023, 18 trials, 827 women
2.4 kg
Less body weight than control groups, in adults with overweight or obesity
Wang et al. 2021, 11 trials, 393 adults
25
Back pain trials in a network analysis of Pilates, yoga, tai chi and qigong, with no clear winner
Xiang et al. 2026, Journal of Pain Research
Sources: Yamato et al. 2015, de Campos Junior et al. 2024, Ju et al. 2023, Wang et al. 2021, Xiang et al. 2026. For effect sizes, larger means a bigger benefit.

1. Low back pain

The Cochrane review, led by Tie Yamato and published in 2015, included 10 randomised trials with 510 adults with non-specific low back pain. Six of the trials compared Pilates with what the review called minimal intervention. Against minimal intervention, Pilates lowered pain by about 14 points on a 0 to 100 scale in the short term (under three months), and by about 10.5 points between three and twelve months, based on two trials. Disability fell by about 8 points in the short term and 11 points later on.

Pilates versus minimal intervention for back pain Points lower on a 0 to 100 scale, larger means a bigger improvement Pain, under 3 months 14.1 Pain, 3 to 12 months 10.5 Disability, under 3 months 8.0 Disability, 3 to 12 months 11.2
Source: Yamato et al. 2015, Cochrane Database of Systematic Reviews. Mean differences on a common 0 to 100 scale. Evidence quality was low for the short-term results and moderate for the 3 to 12 month results.

The Cochrane authors found no high-quality evidence for any comparison, and no conclusive evidence that Pilates beats other exercise. They suggested the choice can rest on personal preference and cost. A later review by Antonino Patti and colleagues, published online in 2023, meta-analysed 19 studies and concluded Pilates can ease back pain compared with both no exercise and non-specific exercise. So the reviews disagree on whether Pilates beats other exercise.

A 2026 network meta-analysis by Yi Xiang and colleagues compared yoga, Pilates, tai chi and qigong across 25 trials in chronic low back pain. All four had lower estimated pain scores than control groups, with no clear difference between them. The certainty of the evidence was low, and the authors said the evidence does not establish a preferred type or an optimal dose. The NHS lists walking, swimming, yoga and Pilates among activities that may help ease back pain.

2. Balance in older adults

A 2024 meta-analysis by Jorge de Campos Junior and colleagues reviewed 39 studies with 1,770 older adults. Pilates improved dynamic balance, static balance and general balance compared with control groups, with an effect size of 0.76 for general balance. Only 14 of the studies had satisfactory quality, and the certainty of evidence ranged from very low to moderate.

Two findings set limits. The review found no reduction in the number of falls or in fear of falling, and Pilates performed about the same as other forms of exercise. An earlier 2021 review of 12 studies by Larissa da Silva and colleagues was more positive. It found improvements in mobility, gait, postural stability and fear of falling, and said Pilates may lower the risk of falls, but noted that high-quality evidence on falls themselves is missing.

3. Depression and anxiety symptoms

A 2018 meta-analysis by Karl Fleming and Matthew Herring pooled eight controlled trials that compared Pilates with groups who did not exercise. The trials reported large reductions in depressive and anxiety symptoms and in feelings of fatigue. The authors noted the trials were few and small, with controls of variable quality, and called for better-designed trials.

A 2023 meta-analysis by Mingxiao Ju and colleagues focused on 827 women with depressive disorders or raised depression scores, across 18 randomised trials. It found moderate evidence that Pilates lowered depression symptoms, with an effect size of 0.73, and anxiety symptoms, with an effect size of 0.62. The authors described Pilates as a potential add-on programme. If anxiety or low mood affects your daily life, the NHS advises you to see a GP, and adults can refer themselves to NHS talking therapies. For urgent help, call 111 and select the mental health option, or call Samaritans on 116 123. Call 999 or go to A&E if someone's life is at risk or you cannot keep yourself safe.

4. Body weight and body fat

A 2021 meta-analysis by Yi Wang and colleagues pooled 11 randomised trials with 393 adults with overweight or obesity. Pilates lowered body weight by about 2.4 kg, body mass index by about 1.2 points and body fat by about 4.2 percentage points. It did not change waist size or lean body mass. The authors called for larger, better-designed trials to confirm the results.

Where Pilates fits in your week

The NHS lists Pilates among muscle-strengthening activities, alongside lifting weights, resistance bands and body-weight exercises. NHS guidelines ask adults to do strengthening activities on at least 2 days a week, plus at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity. Pilates can help cover the strength part, as long as it works all the major muscle groups. You still need aerobic activity, such as brisk walking or cycling, on top. For adults aged 65 and over, the NHS asks for activities that improve strength, balance and flexibility on at least 2 days a week.

How to start

The plan below is our coaching suggestion. For back pain, a 2025 review of 57 core training trials by Xu Bin Guo and colleagues used meta-regression to suggest 2 to 3 Pilates sessions a week of about 50 minutes, over 8 to 12 weeks. The 2026 network analysis cautioned that the evidence does not establish an optimal dose, so treat this as a starting point.

WEEKS 1 AND 2
Try a beginner class
Book a beginner mat or reformer class. Tell the instructor about any back, knee or shoulder problems, or other health conditions, before you start.
WEEKS 3 AND 4
Settle on two sessions
Move to two sessions a week on separate days. A class that works all the major muscle groups can count towards the NHS strength guideline.
WEEKS 5 TO 12
Build the habit
Add a third session if you enjoy it and recover well. Note your back pain, balance or mood each week so you can judge the change.
EVERY WEEK
Keep the aerobic work
Pair Pilates with brisk walking, cycling or swimming to reach the NHS aerobic guideline.

The NHS advises you speak to a GP first if you have not exercised for some time or have medical conditions. For back pain, see a GP if it does not improve after a few weeks of home treatment, stops your daily activities, or worries you. Ask for an urgent GP appointment or call 111 if back pain comes with feeling hot, cold or shivery, or severe pain that starts suddenly or gets worse quickly. Call 999 or go to A&E if, for example, back pain comes with pain, tingling, weakness or numbness in both legs, loss of feeling around your genitals or bottom, changes in bladder or bowel control, or chest pain, or if it started after a serious accident.

Common mistakes

  • Treating Pilates as the only answer to back pain. Reviews disagree on whether it beats other exercise, so pick the option you will keep doing.
  • Expecting fewer falls from Pilates alone. It improved balance in older adults, but the 2024 review found no reduction in the number of falls.
  • Skipping aerobic activity. Pilates counts as strengthening work in NHS guidance, not as your 150 minutes of aerobic activity.
  • Measuring progress by waist size. In the 2021 weight meta-analysis, Pilates lowered weight and body fat but did not change waist size.

Frequently asked questions

Is Pilates good for back pain?
Compared with minimal intervention, yes. A Cochrane review found low to moderate quality evidence that Pilates reduced pain and disability, but no conclusive evidence that it beats other exercise. The NHS lists Pilates among activities that may help ease back pain.
Does Pilates prevent falls?
It improved balance in older adults in a 2024 review of 39 studies, but that review found no reduction in the number of falls or in fear of falling. High-quality evidence on falls is still missing.
Can Pilates help you lose weight?
In adults with overweight or obesity, a 2021 meta-analysis found Pilates lowered body weight by about 2.4 kg and body fat by about 4.2 percentage points. Waist size and lean mass did not change.
Mat or reformer Pilates?
The summaries of the reviews in this guide do not compare mat and reformer classes. Mat classes need little equipment. Reformer classes use a machine with springs for resistance. Choose the one you will attend regularly.
How often should I do Pilates?
For back pain, a 2025 review of core training trials used meta-regression to suggest 2 to 3 sessions a week of about 50 minutes over 8 to 12 weeks. The evidence does not yet establish an optimal dose.

The bottom line

Meta-analyses found Pilates eased low back pain, improved balance in older adults, lowered depression and anxiety symptoms, and reduced body weight and body fat in adults with overweight or obesity. The trials were often small and of low quality. Pilates has not been shown to reduce falls, and reviews disagree on whether it beats other exercise for back pain. Two sessions a week that work all major muscle groups can count towards the NHS strength guideline. Add aerobic activity to complete your week.

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Sources

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