Does Pilates improve pain in older adults with low back pain? A systematised literature review

Purpose: Chronic low back pain (CLBP) is a major cause of disability in older adults and the leading cause of work absenteeism and productivity loss worldwide. With an ageing population and the pension age rising to 68 by 2045 in the United Kingdom (UK), older adults face growing economic and health pressures. Exercise and physical activity-based interventions have been identified as essential for maintaining productivity and well-being and form an integral part of clinical guidelines for CLBP management, offering safer, more effective relief than pharmacological treatments for older adults Despite this, research is yet to comprehensively establish the most effective exercise intervention for CLBP. Pilates has shown potential in reducing CLBP in primary research trials, however, there is a paucity of existing reviews on the efficacy of Pilates in improving pain in older adults with CLBP.
This review aims to evaluate the effectiveness of Pilates in improving pain for adults aged 60 and over with CLBP.
Methods: This review followed a systematised literature review design using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines. Seven electronic databases (Medline, CINAHL Ultimate, Academic Search Complete, AMED, SPORTDiscus, PubMed, and the Cochrane Library) were searched between 1st January 2015 and 18th March 2025. Eligible studies were randomised controlled trials (RCTs) published in English that used pain intensity measures to evaluate the effectiveness of Pilates interventions for adults aged 60 and over with CLBP. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) Randomised Controlled Trial Checklist and the Cochrane Risk of Bias tool. Data were analysed descriptively.
Results: Three RCTs with a total of 261 participants aged 60 and over with CLBP met the inclusion criteria. Two studies assessed Pilates combined with physiotherapy versus a control group who completed standard physiotherapy alone, whilst the third compared Pilates to a home exercise leaflet. Pilates, conducted twice weekly for 45-60 minutes over 6-10 weeks, showed statistically significant pain reduction compared to control groups (p < 0.05), with larger effect sizes and sustained improvements at follow-up. However, study quality varied, with some trials at higher risk of bias due to inadequate allocation concealment and blinding.
Conclusion(s): This review shows that Pilates, conducted for at least six weeks twice weekly, can effectively reduce pain intensity in the short and long term in this population. The evidence, however, is limited by small sample sizes, a lack of demographic diversity restricting generalisability and high or unclear risk of bias. More high-quality research, including diverse populations and larger sample sizes, would strengthen these recommendations.
Impact: Physiotherapists should consider using Pilates as an evidence-based, non-pharmacological intervention to reduce pain intensity in older adults with CLBP. As demand for effective, non-pharmacological care grows, education providers could integrate Pilates training into curricula to equip future clinicians with skills required to address musculoskeletal conditions in our ageing population.