Pilates

What it is

Pilates is an exercise programme that is popular in clinical practice, including for back pain [1]. Programmes differ in format and in whether a certified instructor supervises them [2].

What the research says

For chronic low back pain, a Cochrane review of 10 trials (510 people) found Pilates reduced pain more than minimal treatment, by about 14 points on a 0 to 100 scale in the short term [1]. A network meta-analysis of 217 trials found moderate to clinically important pain relief from Pilates compared with minimal treatment [3]. Compared with other exercise, no clear winner emerges: the Cochrane review found no significant difference in disability [1], and a 2023 review found no strong evidence to prefer one type of exercise [4].

For back pain in pregnancy, two small trials (65 women) found Pilates reduced pain more than no exercise [5]. For older adults, a 2021 meta-analysis linked Pilates to fewer falls, with moderate certainty [2], while a 2024 review found better balance but no clear reduction in falls [6].

Doses used in studies

A network meta-analysis suggested programmes of 3 to 9 weeks with one or two sessions a week gave the most benefit [7]. These are the patterns in the trials, not recommendations.

Safety and interactions

Two trials in the Cochrane review reported adverse events: one found none and another reported minor events [1]. Pregnancy trials reported no adverse effects, but they were small [5]. The abstracts read for this page do not report medicine interactions, upper intake limits or toxic doses, so no data were found for those. People with a spinal condition, recent surgery or other health problems should check with a doctor before starting.

Caveats and open questions

Most reviews rate the evidence as low to moderate quality and found no high-quality trials [1]. Trials mostly compared Pilates with minimal treatment, so comparisons with other exercise rest on fewer studies [4]. Effects on falls in older adults conflict between reviews [2][6].