Pilates for Multiple Sclerosis: Can It Help Patients Improve Balance?

Pilates may help patients with multiple sclerosis (MS) improve balance, according to study findings published in the journal Multiple Sclerosis and Related Disorders.

About 75% of patients with MS experience challenges with balance throughout the disease, which impacts the central nervous system. A meta-analysis of studies with small sample sizes indicated exercise training had a small, positive effect on MS patients’ ability to maintain balance. Prior research has indicated healthy individuals may improve their balance through Pilates, a mind-body exercise that focuses on improving flexibility, strength, core stability, posture, and breathing.

This is the first meta-analysis to evaluate whether Pilates improves balance of individuals with MS, the researchers said.

They included 8 studies (5 randomized controlled trials, 3 non-randomized controlled trials) from Cochrane Library, Physiotherapy Evidence Database (PEDro), MEDLINE, CINAHL (EBSCO), PUBMED, OVID, Science Direct, and Scopus that were control trials that investigated the use of Pilates in patients with MS with at least 1 outcome of balance or postural control.

Based on the PEDro scale, 2 studies had fair methodological quality and 3 had good methodological quality while the non-randomized controlled trials met the majority of criteria. The studies included 349 patients with Expanded Disability Status Scale (EDSS) of no more than 6. Programming took place for 8 to 12 weeks, with 30 to 60 minute sessions 1 to 3 times weekly. Three of 6 studies analyzing the effects on balance found that Pilates was significantly more effective compared with the control group. The other three found no significant difference between Pilates and the control group.

Based on Berg balance scale (BBS), pooled results of the interventions in the meta-analysis indicated Pilates was more effective compared with the control group intervention (Standard Mean Differences [SMD] 1.017, Effect Size [ES] 1.017; P =.041 for both). Pooled results of interventions in the meta-analysis of studies that analyzed Pilates effect on Activities-Specific balance confidence scale (ABC) indicated Pilates was more effective compared with control group (ES 0.604, SMD 0.604; P =.024).

Studies analyzing balance based on Time Up and Go Test (TUG) showed mixed results. Pooled results showed Pilates was more effective compared with the control group (SMD 0.944, ES 0.944; P =.045).

Pooled results of interventions assessing impact of Pilates on balance with Functional Reach Test (FRT) scores showed Pilates was not more effective compared with interventions.

Analysis with Four square step Test, Biodex balance system, and fall efficacy scale international indicated Pilates improved balance.

Study limitations relate to generalization, heterogeneity of the results, and exclusion of studies published in other languages besides English.

“The results of this review demonstrate that Pilates exercises may improve balance, though the mechanism of action is not clear,” the researchers said.

Possible reasons Pilates may help patients with MS include Pilates’ improvement of muscle strength in the trunk and lower extremities and subsequent improvements to neural adaptations or the social interaction of group exercise, they said.

“…We need further robust studies to prove whether it is more effective than other physiotherapy interventions,” the researchers concluded.


Arik MI, Kiloatar H, Saracoglu I. Do Pilates exercises improve balance in patients with multiple sclerosis? A systematic review and meta-analysis. Multiple Sclerosis and Related Disorders. Published online November 25, 2021. doi: 10.1016/j.msard.2021.103410