Efficacy of Pilates on chronic low back pain in women: A systematic review and meta-analysis

Background Chronic low back pain (CLBP) is the most frequent musculoskeletal disorder with many influencing factors, impairing the individual's pain and function management. Objective We conducted this study to explore the effect of Pilates exercise on pain and function in women with CLBP, especially in postmenopausal women. Methods PubMed, Embase, Web of Science, Cochrane Library, PEDro and CINAHL were searched up to April 11, 2026. Randomized controlled trials on the effect of Pilates exercise on women with CLBP vs. no intervention or other interventions were included. SMDs with 95% CIs were estimated by a random-effects model. Subgroup analyses were conducted by age, follow-up time, and region. In addition, subgroup analyses based on follow-up time and region were performed among postmenopausal individuals. We assessed the included studies for risk of bias by the NIH Quality Assessment Tool for Controlled Intervention Studies, sensitivity analysis by the leave-one-out method, and for publication bias by the funnel plot and Egger's test. Results The meta-analysis revealed that Pilates achieved pain relief (SMD −1.88, 95% CI −2.46 to −1.31) and functional improvement (SMD −1.08, 95% CI −1.43 to −0.74). Both menopausal (pain: SMD −2.07, 95%CI −2.90 to −1.25) (function: SMD −1.11, 95% CI −1.53 to −0.7 0) and non-menopausal (pain: SMD −1.58, 95%CI −2.13 to −1.03) (function: SMD −1.03, 95% CI −1.75 to −0.31) women benefited from Pilates, with pain relief and functional improvements. P < 0.001. Conclusions Pilates exercise can achieve pain relief and functional improvement in women both in postmenopausal and non-postmenopausal populations.