Can Pilates Improve Balance in Older Adults? Evidence and Teaching Implications
EFWA Pilates Knowledge
Can Pilates Improve Balance in Older Adults? Evidence and Teaching Implications
Direct answer: Pilates may improve measured balance and aspects of physical function in some older adults, particularly when compared with no structured exercise. That is useful evidence, but it does not prove that Pilates prevents falls. Balance tests, fall-risk scores and the number of falls are related outcomes—not interchangeable ones.
What the strongest reviews suggest
A 2021 systematic review and meta-analysis included 39 randomised trials involving adults aged 60 and over. Compared with inactive or usual-activity control groups, Pilates produced favourable average effects for balance, strength, flexibility and function. The authors rated certainty as low for balance, flexibility and function, and moderate for strength and fall-risk outcomes.
A 2023 review focused specifically on balance and also reported favourable findings for static and dynamic balance. Results were not uniform across every intervention, and the static-balance analysis showed some heterogeneity. Together, these reviews support a cautious statement: Pilates may be a useful way to train balance-related capacity in selected older adults.
Why “better balance” does not equal “fewer falls”
Many studies use performance tests—such as standing balance, functional mobility or composite risk scores—because actual falls require longer follow-up and careful recording. A better score may indicate improved capacity, but it cannot by itself confirm that fewer falls occurred.
A separate 2021 systematic review found improvements in some fall-risk factors but highlighted the lack of high-quality evidence that Pilates reduces actual falls. This distinction matters in public communication. “Pilates can prevent falls” is a stronger claim than the current evidence can support.
Falls are also influenced by medication, vision, footwear, home hazards, illness, cognition and previous falls. One class format cannot manage this whole risk picture.
Practical application for instructors
Established principle: balance improves when participants practise tasks that genuinely challenge balance at an appropriate level. A session composed almost entirely of supported, lying exercises should not automatically be described as a complete balance programme.
EFWA expert interpretation: Pilates instructors can make their contribution clearer by planning across several movement demands:
- Base of support: progress from wider, well-supported positions towards narrower or less supported positions when appropriate.
- Weight transfer: include controlled shifts forwards, backwards and sideways rather than training in one plane only.
- Transitions: practise getting down, up, turning and changing direction where the participant can do so safely.
- Sensory conditions: vary visual focus, surface feedback or hand support carefully; remove support only when a reliable alternative is available.
- Strength contribution: include progressive lower-limb loading, while recognising that Pilates should not automatically be assumed to deliver every element of a complete strength programme.
- Meaningful progression: change one variable at a time and record how the participant responds.
For a person with recurrent falls, unexplained dizziness, fainting, new neurological symptoms or a sudden change in mobility, the correct next step is appropriate healthcare assessment—not a more difficult balance exercise.
How Pilates fits a broader activity plan
Pilates may contribute to balance, strength, mobility and confidence, depending on programme design. Current UK Chief Medical Officers’ guidance treats aerobic activity, muscle strengthening and balance as complementary parts of an older adult’s activity plan. The exact programme should still suit the person’s health, goals and abilities. Pilates can be one component without being presented as the only necessary component.
Evidence limitations
Programmes vary in format, dose, supervision and participant health. Many studies are small, and inactive control groups can make any structured activity appear more favourable. The evidence is stronger for changes in measured balance than for actual fall incidence. Results from healthy volunteers should not be generalised to frail adults or people with complex medical needs.
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EFWA’s Academic Team connects exercise science with responsible professional practice. Students and instructors can also compare EFWA’s Pilates education pathways for further study.
This article is an evidence-informed educational overview, not an individual falls assessment or clinical recommendation.
Author disclosure: Dr Onen is EFWA’s Founder and Academic Director. EFWA provides Pilates education. No independent reviewer is named for this article.
Related reading
References
- da Silva, L. D., Shiel, A., & McIntosh, C. (2021). Pilates reducing falls risk factors in healthy older adults: A systematic review and meta-analysis. Frontiers in Medicine, 8, 708883. https://doi.org/10.3389/fmed.2021.708883
- Fernández-Rodríguez, R., Álvarez-Bueno, C., Ferri-Morales, A., Torres-Costoso, A., Pozuelo-Carrascosa, D. P., & Martínez-Vizcaíno, V. (2021). Pilates improves physical performance and decreases risk of falls in older adults: A systematic review and meta-analysis. Physiotherapy, 112, 163–177. https://doi.org/10.1016/j.physio.2021.05.008
- Oliveira, L. S., de Oliveira, R. G., da Silva, T. Q., Gonzaga, S., & de Oliveira, L. C. (2024). Effects of Pilates exercises on strength, endurance and muscle power in older adults: Systematic review and meta-analysis. Journal of Bodywork and Movement Therapies, 39, 615–634. https://doi.org/10.1016/j.jbmt.2024.02.021
- Sampaio, T., Encarnação, S., Santos, O., Narciso, D., Oliveira, J. P., Teixeira, J. E., Forte, P., Morais, J. E., Vasques, C., & Monteiro, A. M. (2023). The effectiveness of Pilates training interventions on older adults’ balance: A systematic review and meta-analysis of randomized controlled trials. Healthcare, 11(23), 3083. https://doi.org/10.3390/healthcare11233083
- Department of Health and Social Care. (2026, July 10). UK Chief Medical Officers’ physical activity guidelines. GOV.UK. Physical activity guidelines
