The Benefits of Pilates: What the Research Actually Shows

By Katherine, Lead Instructor, Certified Pilates Instructor

Pilates has its best research support for chronic lower back pain, where it reduces pain and disability compared with minimal care, and it shows promising but less certain benefits for core strength, sleep, function in older adults and body composition in adults with overweight or obesity. Most of the evidence is low to moderate in certainty, and Pilates has not been consistently shown to beat other exercise.

Key takeaways

• The best-supported benefit is relief of chronic lower back pain and disability compared with minimal intervention, based on low-to-moderate quality evidence (Yamato et al., 2016).

• An umbrella review of 27 systematic reviews found benefits for pain, disability, sleep quality, balance, body mass index and body fat percentage, but rated the certainty of evidence as very low to moderate (Xu et al., 2023).

• Evidence is weaker for posture, flexibility, balance and anxiety or depression, and Pilates has not been shown to prevent falls.

• There is no evidence that Pilates makes muscles longer or spot-reduces fat, and posture gains need ongoing practice.

What does the research say about the benefits of Pilates overall?

The most useful starting point is an umbrella review, which is a review of existing systematic reviews. A 2023 umbrella review pooled 27 systematic reviews with meta-analyses of Pilates. It found that, compared with inactive or active comparison groups, Pilates can reduce body mass index and body fat percentage, relieve pain and disability, and improve sleep quality and balance. The authors graded the certainty of that evidence as very low to moderate, and only 1 of the 27 reviews was rated high quality using a standard appraisal tool, with 10 rated critically low (Xu et al., 2023).

It also matters what Pilates is being compared with. In many trials the comparison is no exercise or minimal care, so a benefit tells you that Pilates beats doing nothing, not that it beats another reasonable form of exercise. Where the comparison is another type of exercise, the reviews cited below found smaller differences or none.

New to the method? Start with what Pilates is and how it works.

How strong is the evidence for each benefit?

The table below groups the benefits into three tiers. "Stronger" is relative: it means consistent findings in systematic reviews of randomized trials, graded low to moderate in certainty, which is about the best the Pilates literature currently offers. It does not mean high certainty. "Moderate" means positive findings in reviews, but with large variation between trials, a narrow population or no formal certainty rating. "Limited" means findings are inconsistent, indirect, based on weak measures, or absent for the outcome people most care about.

Benefit	Evidence tier	What the research shows	Main caveat
Chronic lower back pain	Stronger	Less pain and disability than minimal intervention (Yamato et al., 2016)	Not shown to beat other exercise
Physical function in adults 55+	Moderate	Moderate gains in a combined set of physical measures versus inactive controls (Meikis et al., 2021)	Smaller gain versus other exercise, no certainty rating
Core muscle strength	Moderate	Not inferior to equivalent exercise, can beat non-equivalent or no exercise (Franks et al., 2023)	Emerging evidence, in chronic back pain
Sleep quality	Moderate	Lower PSQI scores in 6 trials (Chen et al., 2020)	Very uneven results, not significant in healthy people over 40
Body composition	Moderate	Small reductions in weight and body fat (Wang et al., 2021)	Only in adults with overweight or obesity
Balance	Limited	About half of balance comparisons showed a benefit (Sampaio et al., 2023)	Inconsistent, and no high-quality evidence on actual falls
Posture	Limited	Short-term gains in some postural measures (Li et al., 2024)	Measures vary, no certainty rating
Flexibility	Limited	Included in combined measures in older adults (Meikis et al., 2021)	No separate effect size we can verify
Anxiety and depression	Limited	Not reliably improved (Tsartsapakis et al., 2026)	Quality of life and self-esteem fare better

Which benefits have the strongest support?

Chronic lower back pain

This is the benefit with the clearest evidence. A Cochrane review (republished in the journal Spine) of 10 randomized trials with 510 participants found that, compared with minimal intervention, Pilates reduced pain and disability, with mostly medium effect sizes and low-to-moderate quality evidence. It was unclear whether Pilates was better than other exercise for short-term pain, and for disability there was moderate-quality evidence of no significant difference between Pilates and other exercise. The authors concluded there is no conclusive evidence that Pilates is superior to other forms of exercise (Yamato et al., 2016).

In plain terms, Pilates is a reasonable, evidence-supported way to exercise with chronic back pain, but it is not a cure and not uniquely better than other well-chosen exercise. We cover how to start safely in Pilates for lower back pain.

Which benefits are promising but less certain?

Core strength

A systematic review of 8 randomized trials in people with chronic low back pain found that Pilates was not inferior to equivalently dosed exercise, and could be superior to non-equivalent or no exercise, for improving core muscle strength as shown by muscle thickness on ultrasound. The authors describe this as emerging evidence, not settled fact (Franks et al., 2023).

Two cautions apply. The finding comes from people with chronic back pain, and "not inferior" means about as good as comparable exercise, not better. For what instructors mean by the word, see what "engage your core" actually means.

Physical function in older adults

A meta-analytical review of 51 randomized trials with 2,485 adults aged 55 and older (average age 66.5) found moderate effects on a combined group of physical measures (muscle strength, balance, endurance, flexibility, gait and physical functioning) when Pilates was compared with inactive controls, and small to moderate effects when it was compared with active controls. The authors noted substantial variation between studies, and concluded that Pilates appears to be a safe, adaptable and promising approach for a varied group of older adults (Meikis et al., 2021).

Because six outcomes were pooled, the review cannot say how much of the gain is strength, balance or flexibility. See Pilates after 50 for more on this group.

Sleep quality

A meta-analysis of randomized trials found that Pilates groups reported better self-rated sleep quality than non-exercising controls, but results varied widely between trials and were not significant for healthy people over 40 (Chen et al., 2020). The honest summary is "possibly helpful, with mixed results", and the evidence is about general sleep quality, not insomnia; our post on Pilates, stress, anxiety and sleep covers the details.

Body composition

A meta-analysis of 11 randomized trials with 393 adults who had overweight or obesity found that Pilates reduced body weight (about 2.4 kg on average), BMI and body fat percentage, with larger changes in weight and BMI in longer programs. It found no significant effect on waist circumference or lean body mass, and the authors called for larger, better-designed trials (Wang et al., 2021).

This is a modest effect in a specific group, and it should not be read as "Pilates is a weight-loss method for everyone". For the full picture, see does Pilates help you lose weight.

Quality of life and self-esteem

A 2026 systematic review and meta-analysis of 32 randomized and quasi-experimental trials (1,264 participants) supports Pilates as a feasible exercise option with benefits for positive psychosocial outcomes such as quality of life and self-esteem. The pooled result was statistically inconclusive before adjusting for outcome type, and results varied widely between studies (Tsartsapakis et al., 2026).

Where is the evidence limited?

Balance and falls

In older adults, balance results are inconsistent: about half of the balance comparisons in one review showed a significant benefit from Pilates (Sampaio et al., 2023), and another review found an absence of high-quality evidence that Pilates reduces actual falls (da Silva et al., 2021). Better balance, mobility and confidence are plausible reasons to try Pilates, but claiming it prevents falls is not supported; the full evidence is in Pilates for balance and fall risk.

Posture

A 2024 systematic review of 13 studies with 783 participants concluded that Pilates is valuable for improving body posture and can be used as a complementary approach, with about 46% of the studies rated high quality or above and the authors calling for more detailed research (Li et al., 2024). The measures used to assess posture vary between studies, and the review does not give a formal certainty rating, so this is best read as "may help, particularly while you keep training". Our full discussion is in can Pilates improve your posture.

Flexibility

Pilates is widely taught as improving flexibility, but in the older-adult review above, flexibility was pooled with five other measures, so there is no reliable flexibility-only figure (Meikis et al., 2021). We explore what is known in does Pilates improve flexibility.

Anxiety and depression

The 2026 meta-analysis described above concluded that evidence for negative psychological indicators such as depression and anxiety remains limited or non-significant (Tsartsapakis et al., 2026). Pilates should not be treated as a substitute for professional care if you are living with anxiety or depression.

Which Pilates myths should you drop?

"Pilates lengthens your muscles." There is no evidence for this. A systematic review and meta-analysis of 65 studies of static stretching found that repeated stretching sessions raised stretch tolerance (how much stretch you can tolerate) and that stretching reduced stiffness slightly, but neither a single session nor repeated sessions changed fascicle length, the length of the bundles of muscle fibres (Ingram et al., 2025). That study looked at stretching, not Pilates specifically, but it points in the same direction: flexibility can improve without muscle tissue becoming longer. Any "long and lean" look is better explained by strength, body composition and how you carry yourself.

"Pilates burns belly fat." Targeted exercise does not preferentially remove fat from the area you train. A meta-analysis of 13 studies with 1,158 participants found essentially no spot-reduction effect, with a pooled effect size of -0.03 (Ramirez-Campillo et al., 2022). Strong abdominal muscles are a real benefit, but they will not by themselves change where your body stores fat.

"Pilates fixes your posture for good." The posture studies show improvement in specific measures during supervised programs (Li et al., 2024). Nothing in the evidence we reviewed shows that posture stays changed after you stop, and everyday habits are likely to keep shaping how you hold yourself. Think of it like any other fitness adaptation: it holds up with practice.

"Pilates prevents falls." The research supports improvements in some fall-risk factors, such as mobility and fear of falling, not a proven reduction in actual falls (da Silva et al., 2021).

Who benefits most from Pilates?

Based on the research above, the groups with the most direct evidence are:

• People with chronic, non-specific lower back pain, where Pilates has the clearest evidence against minimal care (Yamato et al., 2016).

• Adults aged 55 and older, who were the focus of a 51-trial review of physical function (Meikis et al., 2021).

• Adults with overweight or obesity looking for modest changes in body weight and body fat, alongside other activity (Wang et al., 2021).

Beyond those groups, the evidence is thinner, which is not the same as saying Pilates does not help. If you want a lower-impact way to build strength and body awareness, Pilates is a reasonable option, and an instructor can adapt the work to you. If you are choosing between formats, see private versus group Pilates.

How can you get the most from Pilates?

• Be realistic about timelines. The studies measure change across a program of repeated sessions, not a single class, and the body composition review found larger changes in weight and BMI with longer programs (Wang et al., 2021). Our guide to how long it takes to see results from Pilates explains what to expect.

• Be consistent. The 2026 mental health meta-analysis found that low-frequency programs, including once-weekly sessions, were associated with improvements, but variability in how programs were run means no ideal dose can be stated (Tsartsapakis et al., 2026). For planning your week, see how often to do Pilates.

• Consider supervised instruction, especially as you get older. In the 2026 review, remote and in-person delivery gave comparable results in general adult samples, but individual studies suggested face-to-face, supervised sessions may be advantageous for older adults (Tsartsapakis et al., 2026).

• Combine Pilates with other activity. Canada's 24-Hour Movement Guidelines for adults recommend at least 150 minutes of moderate to vigorous aerobic activity a week and muscle-strengthening activities at least twice a week, and note that progressing toward these targets brings health benefits (CSEP, 2020). Pilates can sit comfortably inside that picture, but it is not usually designed to raise your heart rate the way brisk walking does.

• Tell your instructor about injuries and health conditions. Good Pilates is adapted to you. In our sessions we adapt exercises to your body and work alongside your health care provider.

Safety note: This article is general information, not medical advice, and it does not replace an individual assessment. If you have ongoing pain, a recent injury or surgery, osteoporosis, a heart or blood pressure condition, are pregnant or postpartum, or have a medical condition you are managing, speak with your family doctor or a physiotherapist before starting a new exercise program, and tell your instructor so sessions can be adapted. Stop any movement that causes sharp, radiating or worsening pain. See a doctor promptly for new numbness or weakness, unexplained weight loss or fever, and call 911 for chest pain, significant shortness of breath or sudden loss of bladder or bowel control. Pilates is not a treatment for anxiety, depression, insomnia or any other medical condition.

Experience the benefits in a Small Group Pilates Class in Markham

If you would like to see how Pilates feels in your own body, our Small Group Pilates Class is a reformer class limited to a maximum of three people, so your instructor can adjust the work to you within a 55-minute session. Drop-ins are welcome, which makes it easy to try without a long commitment. We welcome people from across Markham and York Region; reserve your spot to get started.

Frequently asked questions

Is Pilates enough exercise on its own?

For most adults, probably not by itself. Canadian guidelines call for aerobic activity as well as muscle strengthening (CSEP, 2020), and Pilates is not usually designed to raise your heart rate substantially. It works well alongside walking, cycling, swimming or similar activity.

Is Pilates better than other types of exercise?

Not consistently. In the back pain review, Pilates was better than minimal intervention but not shown to be superior to other exercise (Yamato et al., 2016), and in older adults the advantage over other active exercise was smaller than the advantage over no exercise (Meikis et al., 2021). For specific comparisons, see Pilates versus strength training and Pilates versus yoga.

What are the benefits of reformer Pilates?

The reviews we cite do not compare reformer with mat Pilates, so the evidence for reformer Pilates is the evidence for Pilates in general. The best-supported finding is less pain and disability in chronic lower back pain compared with minimal care. Evidence is less certain for core strength in people with chronic back pain, sleep quality, and modest body composition changes in adults with overweight or obesity. See what reformer Pilates is and how it works.

Do the benefits depend on using a reformer?

The reviews cited here pool Pilates studies in general and do not compare reformer and mat directly, so the more useful question is which format you will do consistently; see reformer versus mat Pilates.

Can I do Pilates if I have a health condition?

Often yes, with adaptations, but it depends on the condition and your current symptoms. Check with your doctor or physiotherapist first, and let your instructor know so the program can be adjusted. We do not diagnose or treat medical conditions, and we work alongside your health care provider.

Sources

1. Xu M, Tian C, Wang Y, Liang S, Wang Y, Li X, Yang K (2023). Pilates and multiple health outcomes: An umbrella review. Journal of Science and Medicine in Sport. 26(4-5):232-240. https://pubmed.ncbi.nlm.nih.gov/37076415/

2. Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RWJG, Cabral CMN, Costa LCM, Costa LOP (2016). Pilates for Low Back Pain: Complete Republication of a Cochrane Review. Spine. 41(12):1013-1021. https://pubmed.ncbi.nlm.nih.gov/26679894/

3. Franks J, Thwaites C, Morris ME (2023). Pilates to Improve Core Muscle Activation in Chronic Low Back Pain: A Systematic Review. Healthcare (Basel). 11(10):1404. https://pubmed.ncbi.nlm.nih.gov/37239690/

4. Meikis L, Wicker P, Donath L (2021). Effects of Pilates Training on Physiological and Psychological Health Parameters in Healthy Older Adults and in Older Adults With Clinical Conditions Over 55 Years: A Meta-Analytical Review. Frontiers in Neurology. 12:724218. https://pubmed.ncbi.nlm.nih.gov/34759879/

5. Chen Z, Ye X, Shen Z, Chen G, Chen W, He T, Xu X (2020). Effect of Pilates on Sleep Quality: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Neurology. 11:158. https://pubmed.ncbi.nlm.nih.gov/32265816/

6. Wang Y, Chen Z, Wu Z, Ye X, Xu X (2021). Pilates for Overweight or Obesity: A Meta-Analysis. Frontiers in Physiology. 12:643455. https://pubmed.ncbi.nlm.nih.gov/33776797/

7. Tsartsapakis I, Zafeiroudi A, Kouthouris C (2026). Effects of Pilates-Based Exercise on Mental Health, Psychological Well-Being, and Quality of Life: A Systematic Review and Meta-Analysis. Sports (Basel). 14(5):171. https://pubmed.ncbi.nlm.nih.gov/42188548/

8. Sampaio T, Encarnação S, Santos O, Narciso D, Oliveira JP, Teixeira JE, Forte P, Morais JE, Vasques C, Monteiro AM (2023). The Effectiveness of Pilates Training Interventions on Older Adults' Balance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Healthcare (Basel). 11(23):3083. https://pubmed.ncbi.nlm.nih.gov/38063651/

9. da Silva LD, Shiel A, McIntosh C (2021). Pilates Reducing Falls Risk Factors in Healthy Older Adults: A Systematic Review and Meta-Analysis. Frontiers in Medicine. 8:708883. https://pubmed.ncbi.nlm.nih.gov/34540865/

10. Li F, Omar Dev RD, Soh KG, Wang C, Yuan Y (2024). Effects of Pilates on Body Posture: A Systematic Review. Archives of Rehabilitation Research and Clinical Translation. 6(3):100345. https://pubmed.ncbi.nlm.nih.gov/39372244/

11. Ingram LA, Tomkinson GR, d'Unienville NMA, Gower B, Gleadhill S, Boyle T, Bennett H (2025). Mechanisms Underlying Range of Motion Improvements Following Acute and Chronic Static Stretching: A Systematic Review, Meta-analysis and Multivariate Meta-regression. Sports Medicine. 55(6):1449-1466. https://pubmed.ncbi.nlm.nih.gov/40180774/

12. Ramirez-Campillo R, Andrade DC, Clemente FM, Afonso J, Pérez-Castilla A, Gentil P (2022). A proposed model to test the hypothesis of exercise-induced localized fat reduction (spot reduction), including a systematic review with meta-analysis. Human Movement. 23(3):1-14. https://doi.org/10.5114/hm.2022.110373

13. Canadian Society for Exercise Physiology (2020). Canadian 24-Hour Movement Guidelines for Adults 18 to 64 Years. https://csepguidelines.ca/guidelines/adults-18-64/