Clinician Article

The effects of Pilates exercise training on physical fitness and wellbeing in the elderly: A systematic review for future exercise prescription.

  • Bullo V
  • Bergamin M
  • Gobbo S
  • Sieverdes JC
  • Zaccaria M
  • Neunhaeuserer D, et al.
Prev Med. 2015 Jun;75:1-11. doi: 10.1016/j.ypmed.2015.03.002. Epub 2015 Mar 12. (Review)
PMID: 25773473
Read abstract Read evidence summary
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Geriatrics
    Relevance - 6/7
    Newsworthiness - 5/7
  • Physical Medicine and Rehabilitation
    Relevance - 6/7
    Newsworthiness - 5/7
  • Public Health
    Relevance - 5/7
    Newsworthiness - 5/7


This systematic review aims to summarize the effects of Pilates exercise training (PET) in elderly population on physical fitness, balance and fall prevention, and its effects on mood states, quality of life and independence in the daily living activities.

METHODS: Keyword "Pilates" associated with "elderly", "aging" and "old subjects" were identified as terms for the literature research in MEDLINE, Embase, PubMed, Scopus, PsycINFO and SPORTDiscus. Only studies published in peer-reviewed journals written in English language were considered. A meta-analysis was performed and effect sizes (ES) calculated.

RESULTS: 10 studies were identified (6 RCTs and 4 uncontrolled trials); age ranged from 60 to 80years. Overall, PET showed large ES to improve muscle strength (ES=1.23), walking and gait performances (ES=1.39), activities of daily living, mood states and quality of life (ES=0.94), moderate to high effect on dynamic balance (ES=0.77), small effects on static balance (ES=0.34) and flexibility (ES=0.31), while a small effect on cardio-metabolic outcomes (ES=0.07).

CONCLUSIONS: PET should be taken into account as a way to improve quality of life in the elderly, due to the imparted benefits of fall prevention, physical fitness, and mood states. In this context, physicians might include PET as a tool for exercise prescriptions for the elderly.

Clinical Comments

Family Medicine (FM)/General Practice (GP)

This systematic review identifies large effect sizes of the studied intervention on multiple patient-oriented and intermediate outcomes. The review's implications are somewhat limited by its non-specific health state inclusion criteria; it is difficult to distinguish the intervention's effectiveness among different sub-populations such as healthy senior citizens versus patients with Parkinson's or other chronic diseases.

General Internal Medicine-Primary Care(US)

This is a helpful study as it provided objective and subjective studies, as well as effect sizes.

Physical Medicine and Rehabilitation

This article is very interesting on the surface, but less interesting as I read the methodology. The authors included 4 non-RCTs in their final list of included studies. Worse yet, only 4 of the 10 included studies could be considered "high quality"...yet the authors did not seem to give more weight to the results of the higher quality studies. The was a wide variation in the frequency and duration of the exercise interventions, yet the authors pooled the data from all these heterogenous trials and did meta-analyses. Despite these limitations, it is important for rehab specialists to see this compilation of evidence about Pilates exercise for older adults.

Public Health

This systematic review has concluded that Pilates exercise training should be taken into account as a way to improve quality of life in the elderly, due to the imparted benefits of fall prevention, physical fitness, and mood states. The meta-analysis included only studies published in English and ignored studies published in other languages. 95% of Confidence intervals of strength and dynamic balance outcomes overlap unity. The study included only 6 RCTs.

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