Pilates is good exercise, but its edge over other workouts for back pain isn’t proven

Key takeaways

• In a 2015 Cochrane review of 10 trials with 510 adults, Pilates eased chronic low-back pain more than minimal care but wasn’t clearly better than other exercise¹⁰.
• A 2021 review of 39 trials in adults 60 and older found moderate gains in strength, balance and flexibility, but good evidence that Pilates cuts actual falls is still missing¹¹¹².
• Mat Pilates is light activity by energy cost, rated at 1.8 METs, so count it as strength and balance work, not cardio⁸⁹.
• Pilates isn’t a licensed profession, and the National Pilates Certification Program’s exam requires at least 450 hours of training, so ask any teacher what training they’ve finished⁵⁷.
• If you have osteoporosis, Osteoporosis Canada’s Too Fit To Fracture guidance advises changing deep forward-bending and twisting moves in Pilates and yoga¹⁵.

On September 12, 1915, a German-born circus performer arrived at the Isle of Man’s Knockaloe internment camp¹. When World War I began, British authorities had classed him as an “enemy alien” and arrested him days later. His internee index number was 14001¹.

His name was Joseph Pilates. Over about three and a half years in the camp, he read in its library, supervised sports and helped fellow internees exercise¹. He later said his method, which he called Contrology, was born there².

Today the method carries his name, and nobody owns that name. In 2000, a federal judge ruled that “Pilates” was a generic word, like yoga or karate, that couldn’t be trademarked, the trade magazine Athletic Business reported³. Studios everywhere now use it.

Pilates is good exercise. Some studio promises, though, run ahead of the research. This article covers what the trials show, how mat and reformer classes differ, and how to choose a teacher.

Contrology began in a wartime camp and grew up in a New York gym

Joseph Pilates was born in 1883 in Mönchengladbach, Germany¹². His father, a metalworker and keen gymnast, took him to a gymnastics club and taught him to box¹.

He returned to Germany in March 1919 and in 1925 patented a “Universal Reformer”¹. He arrived at Ellis Island in 1926². In 1927, he opened a gym at 939 Eighth Avenue in New York that stayed open for more than 40 years². Choreographer Martha Graham was among its clients².

He wrote two books, Your Health (1934) and Return to Life Through Contrology (1945), and died in 1967². The method’s principles, as later summarized in American Family Physician, are centering, concentration, control, precision, flow and coordinated breathing⁴.

According to Athletic Business, the 2000 ruling by U.S. District Judge Miriam Cedarbaum threw out trademarks held by Sean Gallagher, owner of a Manhattan studio³. Writing five years later, the magazine dated the modern Pilates era from that decision³.

Some of the founder’s stories deserve a gentle asterisk. The Knockaloe Charitable Trust, which runs an archive on the camp, urges caution about some of his own claims, such as how many internees he taught¹. National Geographic found no evidence for his later claim that Contrology protected trainees from the 1918 flu¹².

Pilates fits natural-health values well. A mat practice needs almost no equipment, and it trains attention to breath and movement. It also asks you to own your body’s care. Respecting the method means testing its claims the same way you’d test anyone else’s.

Mat or reformer: the same method, with springs or without

Mat Pilates uses your body weight on the floor, sometimes with small props. Reformer Pilates uses a sliding carriage with springs that add or ease resistance.

The full method uses more machines. The National Pilates Certification Program (NPCP) expects fully trained teachers to know the mat, reformer, trapeze table (also called the Cadillac), Wunda Chair, ladder barrel, spine corrector and magic circle, a flexible ring⁶.

By energy cost, Pilates is gentle. The 2024 Adult Compendium of Physical Activities, researchers’ standard list of how much energy activities use, rates traditional mat Pilates at 1.8 METs and general Pilates at 2.8⁸. A MET is the energy you burn sitting still, and federal guidelines call anything under 3 light activity⁹.

So Pilates won’t cover your weekly cardio. Fusion classes are a different story: one class that mixes Pilates moves with drumming rates 8.5 METs⁸. Ask what you’re signing up for.

Pilates fits better in the strength slot. Federal guidelines list body-weight moves such as planks as muscle-strengthening activity, which adults need on at least two days a week⁹.

Reformer classes cost more for a reason. In 2005, Athletic Business reported that experts recommended four to six reformers per group class, and six machines cost about $15,000³. We found no independent national survey of class prices.

Format	Equipment	Resistance	Relative cost (our rough guide)	A good fit if you…
Mat at home	A mat; video or book	Body weight	Lowest	Are healthy and want to try it
Group mat class	Mat, small props	Body weight, bands, rings	Low to moderate	Want coaching on form
Group reformer class	Reformer	Springs	Higher	Want adjustable resistance and variety
Private session	Full apparatus	Springs	Highest	Have an injury, osteoporosis or special needs

Pilates builds strength and balance, with the best evidence in older adults

Several reviews have pooled Pilates trials in people 60 and older. A 2021 analysis in the journal Physiotherapy pooled 39 randomized trials, in which people are assigned by chance to Pilates or a comparison group¹¹.

Compared with control groups, Pilates brought moderate gains in strength, balance, flexibility and everyday function¹¹. Scores on fall-risk measures improved by a large amount¹¹. The authors rated the certainty of the evidence as moderate for strength and fall risk, and low for balance, flexibility and function¹¹.

A 2023 review in Healthcare found that about half the Pilates programs it pooled improved balance significantly¹³. Balance while moving did best, with gains in 6 of 9 programs¹³.

Fall-risk scores aren’t falls, though. A 2021 review in Frontiers in Medicine looked at 12 trials with 702 healthy older adults¹². Pilates improved sway, reaching distance and fear of falling¹².

But the falls data were too thin to pool, and the trial the review described found no significant difference in falls¹². The authors noted a lack of high-quality evidence that Pilates reduces falls¹².

So Pilates trains the abilities that help prevent falls. Whether it prevents falls hasn’t been tested well. Our balance articles cover the programs with the strongest fall-prevention record.

If Pilates is your only strength work, consider adding moves that load your legs and arms more heavily. Our strength-training article explains how.

For back pain, Pilates works about as well as other exercise

If you’re trying Pilates for back pain, the best test is a 2015 Cochrane review, from the international network known for careful evidence summaries¹⁰. It pooled 10 trials with 510 adults with nonspecific low-back pain, meaning pain without a known cause such as a fracture¹⁰.

Programs ran 10 to 90 days¹⁰. Sessions, supervised by trained or certified teachers, lasted about an hour and ran from once a day to once a week⁴.

Compared with minimal care, Pilates lowered pain by about 14 points on a 100-point scale in the short term (low-certainty evidence) and by about 10.5 points at 3 to 12 months (moderate certainty)¹⁰. American Family Physician called the short-term drop clinically significant⁴.

Compared with other exercise, such as general exercise or stationary cycling, Pilates didn’t reduce disability any more (moderate certainty)⁴¹⁰. At 3 to 12 months, other exercise improved function slightly more in one trial (low certainty)¹⁰.

The authors’ conclusion: there’s no conclusive evidence that Pilates beats other exercise, so the choice can depend on preference and cost¹⁰. The journal also noted that no review has crowned a single best exercise for chronic low-back pain⁴.

That’s good news if you love Pilates, and good news if you don’t. Later articles in this library cover back pain in depth.

“Core” is real anatomy, and the marketing story around it is shakier

Your core muscles wrap your trunk, and they matter. The trouble is a set of claims built on top of them.

Core stability training grew from late-1990s lab studies¹⁴. They found that a deep abdominal muscle, the transversus abdominis, switched on slightly later in people with chronic back pain during fast arm and leg movements¹⁴. The delays were about 20 thousandths of a second, too fast to control on purpose¹⁴.

In 2010, Eyal Lederman of CPDO Ltd. in London reviewed the evidence in the Journal of Bodywork & Movement Therapies¹⁴. It’s a critical review by one author, not a pooled analysis, so weigh it as expert argument. His findings:

• Myth: a weak core causes back pain. He found no evidence that weaker trunk muscles make back pain more likely. In one study of pregnant women, sit-up ability didn’t track with backache¹⁴.
• Myth: you must first learn to switch on a special deep muscle. No study had shown that core training resets that muscle’s timing in people with back pain¹⁴.
• Myth: hollowing or bracing your belly protects your spine. In the studies he cited, hollowing didn’t add stability, and bracing did but also squeezed the spine harder. He advised discouraging patients from both¹⁴.
• Myth: core training beats other exercise for back pain. It worked about as well as general exercise¹⁴, which matches the Cochrane finding for Pilates¹⁰.

What’s left is useful. A strong trunk is part of a strong body, and planks count as strength work⁹. Lederman’s advice was simple: choose exercise you enjoy¹⁴.

Claim	Evidence rating	What it rests on
Pilates eases chronic low-back pain more than minimal care	Strong evidence	Cochrane review, 6 trials vs. minimal care; low certainty short term, moderate at 3 to 12 months10
Pilates beats other exercise for back pain	Evidence says no	No difference in disability, moderate certainty10
Pilates builds strength in older adults	Strong evidence	39 trials, moderate certainty11
Pilates improves balance, flexibility and fall-risk scores	Promising but early	Mostly low-certainty evidence111213
Pilates prevents falls	Not enough evidence	Falls data too thin to pool; one trial found no difference12
Pilates counts as cardio	Evidence says no	Listed at 1.8 to 2.8 METs, below the 3.0 line89
Weak core muscles cause back pain	Not enough evidence	No evidence they predispose people to it, per one critical review14
Contrology protected trainees from the 1918 flu	Not enough evidence	The founder’s claim; National Geographic found no evidence, and the camp’s archive urges caution12

Bend and twist with care if your bones are thin

Many classic mat moves, such as the roll-up, curl the spine forward. For most people, that’s fine. For people with osteoporosis, it can matter.

Too Fit To Fracture, an expert guidance project published with Osteoporosis Canada in 2014, advises against end-range forward bending and twisting, naming flexion and twisting moves in yoga and Pilates¹⁵. It suggests swaps instead¹⁵:

• Replace deep forward folds with supported bending that hinges at the hips, using a chair.
• Replace twisting moves with slow, controlled rotation while lying on your back, or a side plank against a wall or on the floor.
• Bend at the knees and hips, not the spine, when you lift.

The same guidance encourages strength training at least twice a week, daily balance practice, and 5 to 10 minutes a day of posture and back-extensor work¹⁵. Pilates can deliver much of that with the right changes. Our bone-strength article covers this in depth.

A Pilates certificate can mean very different training. Ask which

The NPCP describes Pilates as an unregulated industry, not a licensed profession⁵. Anyone can call a class Pilates.

Training once varied wildly. In 2005, when the Pilates Method Alliance launched a national exam requiring at least 200 hours of preparation, some internet courses took six hours, Athletic Business reported³.

Today, the NPCP’s comprehensive exam requires a training program of at least 450 hours⁷. Passing earns the NCPT credential, and the program says it’s accredited by the National Commission for Certifying Agencies⁷.

The exam has 125 multiple-choice questions over three hours, and the comprehensive version costs $300⁵⁷. Teachers renew every two years with continuing education⁵. New training standards, which spell out in-person or live online instruction and supervised practice teaching, take effect January 1, 2027⁶.

Many good teachers hold other credentials or trained through a respected school. A certificate is a starting point for your questions, not the answer.

Questions to ask a studio:
– What training has the teacher finished, how many hours, and did it cover mat only or the machines too?
– Is the teacher certified by an independent exam, such as the NCPT?
– How do you start beginners on the reformer: an intro session, a private lesson or a beginner class?
– How many students does one teacher supervise?
– Do you ask about osteoporosis, pregnancy, recent surgery and back problems, and can you show changes for forward bends and twists?
– Is this classical Pilates or a fusion workout with cardio or jumping?
– What does a class cost after the intro deal, and how do I cancel a membership?

A 20-minute beginner mat routine

Do this two or three days a week on a mat or carpet. Breathe steadily, move slowly, and stop two or three reps before your form slips. If you have osteoporosis, keep your head on the mat during the moves on your back; this routine leaves out deep forward curls and twists.

1. Breathing setup (2 minutes). Lie on your back, knees bent, feet flat. Breathe into the sides of your ribs, and exhale slowly through your mouth.
2. Pelvic tilts (2 minutes). Gently flatten your low back into the mat, then return. Do 10 slow tilts.
3. Bridge (3 minutes). Press through your heels and lift your hips until your body forms a line from knees to shoulders. Do 2 sets of 8 to 10.
4. Toe taps (3 minutes). Lift your knees above your hips, shins level. Lower one foot to tap the floor, then switch. Do 2 sets of 8 per side.
5. Side-lying leg lifts (3 minutes). Lie on one side, legs long. Lift the top leg a little higher than your hip. Do 10 per side.
6. Bird dog (3 minutes). On hands and knees, reach one arm forward and the opposite leg back, hold for two breaths, and switch. Do 8 per side.
7. Back extension (2 minutes). Lie face down with forehead on your hands. Lift your head and chest an inch or two, hold briefly, and lower. Do 6 to 8.
8. Modified plank (2 minutes). Rest on your forearms and knees, body in a line. Hold 20 to 30 seconds, twice.

Each week, add a few reps or a few seconds. After a month, try full planks or a beginner class.

Questions readers ask

The bottom line

Pilates is solid exercise with an interesting history. It builds strength, improves balance and flexibility in older adults, and eases chronic back pain about as much as other exercise. It isn’t cardio, it hasn’t been shown to prevent falls, and the special-core story behind some marketing is weaker than it sounds.

Choose Pilates because you enjoy it, ask what training your teacher has, and change deep bends and twists if your bones are thin. Then keep showing up, because steady practice is where the benefits come from.

Related reading

• Yoga builds balance and calm, and the style you choose shapes the risk
• Most adults skip strength training, though under an hour a week goes a long way
• Balance fades after 50, and a 10-second test shows where you stand
• What the letters after a practitioner’s name mean
• The wellness subscription you meant to cancel

Sources

1. Knockaloe Charitable Trust. “Joseph Pilates” (internee profile). Knockaloe.im, accessed October 2026. knockaloe.im
2. National Geographic. “The exercise phenomenon born in a prisoner-of-war camp” (premium article). November 29, 2021, updated February 10, 2023. nationalgeographic.com
3. Athletic Business. “Stretching Out.” Athletic Business, October 31, 2005. athleticbusiness.com
4. Fogleman CD. “Pilates for the Treatment of Low Back Pain” (Cochrane for Clinicians). American Family Physician, 2016;93(7):556-557. aafp.org
5. National Pilates Certification Program. “Frequently Asked Questions.” NPCP, accessed October 2026. nationalpilatescertificationprogram.org
6. National Pilates Certification Program. “Requirements” (eligibility for the Pilates Comprehensive exam). NPCP, accessed October 2026. nationalpilatescertificationprogram.org
7. National Pilates Certification Program. “2026 National Pilates Certification Exam Candidate Handbook.” NPCP, March 2026. files/NPCP/Get Certified/Apply/2026 NPCE ENGLISH Handbook Mar-20-2026.pdf
8. Herrmann SD, Willis EA, Ainsworth BE, et al. “2024 Adult Compendium of Physical Activities: A third update of the energy costs of human activities.” Journal of Sport and Health Science, 2024;13(1). pacompendium.com
9. U.S. Department of Health and Human Services. “Physical Activity Guidelines for Americans, 2nd edition.” HHS, 2018. odphp.health.gov
10. Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RWJG, Cabral CMN, Menezes Costa LC, Costa LOP. “Pilates for low back pain.” Cochrane Database of Systematic Reviews, 2015, Issue 7, CD010265. cochrane.org
11. Fernández-Rodríguez R, Álvarez-Bueno C, Ferri-Morales A, Torres-Costoso A, Pozuelo-Carrascosa DP, Martínez-Vizcaíno V. “Pilates improves physical performance and decreases risk of falls in older adults: a systematic review and meta-analysis.” Physiotherapy, 2021;112:163-177 (CSP research record). acptr.csp.org.uk
12. da Silva LD, Shiel A, McIntosh C. “Pilates Reducing Falls Risk Factors in Healthy Older Adults: A Systematic Review and Meta-Analysis.” Frontiers in Medicine, 2021;8:708883. frontiersin.org
13. Sampaio T, Encarnação SG, Santos OM, et al. “The effectiveness of Pilates training interventions on older adults’ balance: a systematic review and meta-analysis of randomized controlled trials.” Healthcare, 2023;11(23) (Polytechnic Institute of Bragança repository). bibliotecadigital.ipb.pt
14. Lederman E. “The myth of core stability.” Journal of Bodywork & Movement Therapies, 2010;14:84-98 (St Mary’s University copy). stmarys.ac.uk
15. Osteoporosis Canada. “Too Fit To Fracture: Exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture” (patient handout, based on Giangregorio LM, et al., Osteoporosis International, 2014). July 2014. osteoporosis.ca