A systematic review of the effectiveness of Pilates on pain, disability, physical function, and quality of life in older adults with chronic musculoskeletal conditions

Musculoskeletal Care. 2022 Mar;20(1):10-30. doi: 10.1002/msc.1563. Epub 2021 May 24.


Objectives: This systematic review aims to evaluate the effectiveness and delivery of Pilates to reduce pain and disability and to improve physical function and quality of life in middle-aged to older adults with a range of chronic musculoskeletal conditions.

Methods: Searches were conducted using CENTRAL, CINAHL, SCOPUS, Pubmed, PsycInfo, Web of Science Core Collection and Google Scholar. Inclusion criteria were controlled trials and observational studies, population mean age 50 years and over with chronic musculoskeletal conditions, using mat-based Pilates exercise. Outcomes included pain, disability, physical function and quality of life.

Results: Seven studies were included, with a combined total sample of 397 participants (73% female). Pilates was significantly effective (p ≤ 0.05) for reducing back pain, neck pain and pain associated with knee osteoarthritis and osteoporosis. Additional significant disability, physical functioning and quality of life effects were found for back pain, osteoporosis, and knee OA. Overall Pilates was as effective as other exercise. Adherence to group exercise was good, but poor for home exercise. No significant adverse effects were reported.

Conclusion: Pilates is a safe and effective exercise intervention for adults over 50 with a diverse range of musculoskeletal conditions which may otherwise put them at risk of becoming sedentary. Although no overall significant superiority was found over other exercise, participants reported psychosocial benefits particular to the Pilates group exercise, with enjoyment a possible positive factor in adherence. Further research on Pilates exercises for various pathologies could inform teaching and improve engagement with older adults, including those with chronic conditions.

Keywords: Pilates; ageing; chronic musculoskeletal conditions.

Publication types

  • Systematic Review

MeSH terms

  • Aged
  • Chronic Disease
  • Chronic Pain* / psychology
  • Chronic Pain* / therapy
  • Exercise Movement Techniques*
  • Exercise Therapy
  • Female
  • Humans
  • Low Back Pain*
  • Male
  • Middle Aged
  • Musculoskeletal Diseases* / complications
  • Osteoporosis*
  • Quality of Life