Does Pilates Help Older Adults with Balance and Falls? What the Research Says
Falls are the leading cause of injury in later life, and balance is trainable at any age. This page summarises what systematic reviews, randomised trials and international guidelines say about Pilates for adults over 60.
9 studies and guidelines reviewed · Each one linked to its primary source · Last reviewed 1 October 2026
Yes. Three systematic reviews and meta-analyses of randomised trials find Pilates improves static and dynamic balance, strength and walking in adults over 60. Balance-challenging exercise of this kind reduces falls by around a quarter, though most Pilates trials are small and short.
Several controlled trials support the effect, but sample sizes are modest or results vary between studies.
The evidence that Pilates improves balance in older adults is unusually consistent: three independent meta-analyses report moderate-to-large effects on dynamic and static balance, with gains in strength, gait and quality of life. The Cochrane review of 108 trials shows balance and functional exercise in general cuts the rate of falls by roughly a quarter, and WHO recommends this type of training at least three days a week. The caveat is that direct evidence on falls from Pilates trials specifically comes from a handful of small studies, so falls reduction is a well-founded expectation rather than a proven Pilates-specific outcome.
Key findings from the research
- Across six trials, Pilates improved balance in older adults with a large effect versus non-active controls (SMD 0.84) and reduced falls, although only 2–36% of the exercises in those programmes challenged balance to a moderate or high degree (Barker 2015, meta-analysis).
- In 15 randomised trials of people over 60, Pilates improved dynamic balance (SMD 0.75), static balance (SMD 1.33) and overall balance (SMD 0.96) (Moreno-Segura 2018, meta-analysis).
- Pilates produced large effects on muscle strength (ES 1.23), walking and gait (ES 1.39) and quality of life (ES 0.94) in adults aged 60–80, with smaller effects on static balance and flexibility (Bullo 2015, systematic review).
- Exercise reduces the rate of falls in community-dwelling older people by 23% and the number of people who fall by 15%; balance and functional exercise alone cuts falls by 24% with high-certainty evidence (Sherrington 2019, Cochrane review of 108 trials).
- Sixty women over 65 who did Pilates three times a week for 12 weeks improved dynamic balance, flexibility, reaction time and strength, and recorded fewer falls than controls (Irez 2011, RCT).
- Twelve weeks of twice-weekly Pilates improved balance as much as traditional strength-and-balance training in adults at risk of falling, and was the only group to significantly improve balance confidence (Josephs 2016, RCT).
- WHO recommends that adults over 65 do multicomponent activity emphasising functional balance and strength training at moderate or greater intensity on three or more days a week (WHO 2020, guideline).
The studies, one by one
Listed with design, year and a link to the original so you can check every claim. Findings are reported as the authors reported them.
-
The effects of Pilates exercise training on physical fitness and wellbeing in the elderly: a systematic review for future exercise prescription
Finding: Pilates training showed large effects on muscle strength (ES 1.23), walking and gait performance (ES 1.39) and quality of life (ES 0.94), a moderate-to-high effect on dynamic balance (ES 0.77), and small effects on static balance (ES 0.34) and flexibility (ES 0.31). The authors concluded Pilates may reduce fall risk and improve autonomy and mood.
Why it matters here: The biggest gains were in strength and walking, the two capacities most tied to independence in later life.
-
Effect of Pilates exercise for improving balance in older adults: a systematic review with meta-analysis
Finding: Compared with non-active controls, Pilates improved balance (SMD 0.84, 95% CI 0.44 to 1.23) and reduced falls (SMD −2.03, 95% CI −2.66 to −1.40). However, only 2–36% of the exercises in the tested programmes challenged balance moderately or highly, and only one programme exceeded the 50 total hours recommended for falls prevention.
Why it matters here: Programmes for over-60s should deliberately include standing, balance-challenging work rather than staying on the mat.
-
The Effects of the Pilates Training Method on Balance and Falls of Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Finding: Pilates improved dynamic balance (SMD 0.75, 95% CI 0.17 to 1.32), static balance (SMD 1.33, 95% CI 0.53 to 2.13) and overall balance (SMD 0.96, 95% CI 0.00 to 1.91). The authors concluded Pilates may be a beneficial treatment for improving balance and decreasing the number of falls.
Why it matters here: The largest pooled analysis to date, and its confidence intervals are wide, which is why the rating here is Moderate rather than Strong.
-
Exercise for preventing falls in older people living in the community
Finding: Exercise reduced the rate of falls by 23% (rate ratio 0.77) and the number of people falling by 15% (risk ratio 0.85), both high-certainty evidence. Balance and functional exercise reduced falls by 24% (high certainty); programmes combining balance, functional and resistance exercise reduced them by 34% (moderate certainty). Evidence on fractures and hospital admissions was low to very low certainty.
Why it matters here: Pilates is not named separately in this review; its relevance is that a Pilates programme built around balance and functional strength matches the exercise types shown to work.
-
The effectiveness of Pilates on balance and falls in community dwelling older adults
Finding: After 12 weeks of twice-weekly hour-long sessions, both groups improved significantly on the Fullerton Advanced Balance Scale (Pilates +6.31, traditional +7.45 points). Only the Pilates group significantly improved balance confidence on the Activities-Specific Balance Confidence Scale (+10.57 points, p=0.008).
Why it matters here: Pilates matched conventional falls-prevention exercise for balance and did more for confidence, which matters because fear of falling itself restricts activity.
-
The effect of Pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults
Finding: After an eight-week Pilates programme, participants improved significantly on the Timed Up and Go test (p<0.001) and Turn 180 test (p=0.002), with a smaller gain on the Forward Reach test (p=0.049). Participants reported decreased fear of falling; 91% completed the programme.
Why it matters here: Functional mobility measures that predict falls improved within eight weeks, though without a control group the result is supportive rather than conclusive.
-
Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls
Finding: Women who completed one-hour Pilates sessions three times a week for 12 weeks improved dynamic balance, flexibility, reaction time and muscle strength compared with controls (p<0.05), and recorded fewer falls during the study period. Balance, strength and reaction time together contributed to the reduction in falls.
Why it matters here: One of the few Pilates trials to count falls directly rather than only balance scores.
-
A randomized controlled study investigating static and dynamic balance in older adults after training with Pilates
Finding: Five weeks of group Pilates improved static and dynamic balance measures, including mediolateral sway standing on foam with eyes closed (−1.64 cm, effect size 0.72), the Four Square Step Test and Timed Up and Go, with improvements occurring during the Pilates phase but not the usual-activity phase. Between-group differences were not statistically significant.
Why it matters here: Even five weeks produced measurable within-person balance change, but the small sample could not show a clear between-group effect.
-
WHO Guidelines on Physical Activity and Sedentary Behaviour
Finding: Adults aged 65 and over should, as part of their weekly activity, do varied multicomponent physical activity that emphasises functional balance and strength training at moderate or greater intensity on three or more days a week, to enhance functional capacity and prevent falls. Older adults should be as active as their functional ability allows.
Why it matters here: A Pilates practice done three times a week that includes standing balance and progressive strength work aligns with the WHO recommendation.
How Pilates is thought to help ageing, balance & falls (over 60)
Balance depends on strength in the hips, trunk and ankles, on the speed at which muscles respond to a wobble, and on accurate sensory information from the feet and joints. Pilates trains all three: slow, controlled movements against gravity or spring resistance build strength, while the emphasis on precision and body awareness sharpens proprioception.
Falls prevention research shows that exercise must actually challenge balance, for example by narrowing the base of support, moving the centre of mass or reducing hand support. The Barker meta-analysis found many early Pilates programmes did too little of this, which is why well-designed programmes for older adults add standing, single-leg and reaching work rather than staying supine.
Confidence is part of the mechanism. Fear of falling leads people to move less, which weakens them further. The trials that measured balance confidence found Pilates improved it, and participants consistently described the method as enjoyable and achievable, which supports the long-term adherence that falls prevention requires.
What the evidence does not tell us
- Most Pilates trials in older adults are small (13–60 participants) and short (5–12 weeks), and several lack an active control group.
- Falls themselves are rarely the primary outcome; most studies measure balance tests that predict falls rather than counting falls over a year.
- Participants were mostly healthy, community-dwelling volunteers, so the results may not transfer to frail older adults or those with dementia, Parkinson's disease or severe osteoporosis.
- Programmes varied widely in content and instructor training, and the meta-analyses show wide confidence intervals and high heterogeneity.
- The Cochrane falls evidence is for balance and functional exercise in general; Pilates was not analysed as a separate category.
Practical takeaways
- Balance improves with training at any age, and Pilates is one of the better-studied ways for over-60s to do it.
- Aim for at least two, ideally three, sessions a week; that is the dose used in the positive trials and recommended by WHO.
- Make sure the programme includes standing work that genuinely challenges balance, not just floor exercises.
- Expect strength and walking to improve alongside balance; these gains support independence as much as fall reduction.
- If you have osteoporosis, a joint replacement or a history of falls, start with a programme adapted to those conditions and check with your GP or physiotherapist first.
Programmes built on this evidence
Each protocol below applies the principles above as a structured, progressive 8-week plan, with the exercises the trials actually used.
Frequently asked questions
- Does Pilates improve balance in older adults?
- Yes, and this is one of the more consistent findings in Pilates research. Three separate systematic reviews and meta-analyses, pooling up to 15 randomised trials of people over 60, found moderate-to-large improvements in both static and dynamic balance, along with gains in strength, walking speed and quality of life. The trials are small and short, so the exact size of the effect is uncertain, but the direction is clear.
- Can Pilates prevent falls?
- Probably, though the direct evidence is thinner than for balance. A Cochrane review of 108 trials shows that balance and functional exercise reduces the rate of falls by around 24%, and Pilates programmes that include standing balance work deliver that kind of exercise. Two Pilates trials that counted falls found fewer in the Pilates group. Choose a programme that genuinely challenges balance; some early Pilates studies did too little of this.
- How often should someone over 60 do Pilates?
- The trials with the clearest results used two to three sessions a week for eight to twelve weeks, and WHO recommends functional balance and strength training on three or more days a week for adults over 65. Falls-prevention research also suggests total dose matters, with around 50 hours over time as a useful benchmark. Two or three shorter sessions each week, kept up for months, is more effective than an occasional long class.
- Is Pilates safe for people over 60?
- In the trials reviewed here, involving healthy community-dwelling adults aged roughly 60 to 87, Pilates was well tolerated and completion rates were high; one study reported 91% of participants finishing the programme. Safety depends on adaptation: people with osteoporosis should avoid loaded spinal flexion, and anyone with a recent joint replacement, heart condition or history of falls should get medical clearance and begin with supported, progressive exercises.
- How long until Pilates improves balance?
- Measurable change appears quickly. A crossover trial found balance improved within five weeks of group Pilates, an eight-week programme improved Timed Up and Go and turning performance, and twelve-week programmes produced the largest gains in strength, balance and confidence. Balance is a skill that fades without practice, so treat the first two to three months as the start of a habit rather than a course with an end date.
- Mat, chair or reformer Pilates for seniors?
- Most of the older-adult trials used mat-based group classes, sometimes with small equipment, so that is where the evidence sits. Chair-based and wall-supported variations are sensible entry points for people with limited mobility or fear of getting down to the floor. Whatever the format, the research suggests the key is including standing exercises that challenge balance, so a programme should progress from supported to less supported positions over time.
Citing this summary
You are welcome to quote or link to this page with attribution. Please also cite the primary studies listed above.
Pilates Protocols, "Does Pilates Help Older Adults with Balance and Falls? What the Research Says", https://pilatesprotocols.com/evidence/pilates-for-older-adults/ (reviewed 1 October 2026)Note. This page summarises published research for general information and is not medical advice. This page summarises published research for general information and is not medical advice. Older adults with osteoporosis, a recent joint replacement, heart or lung conditions, a history of falls or dizziness should get clearance from their GP or physiotherapist before starting a new exercise programme. Pilates Protocols programmes are educational products, not a substitute for individual clinical care.