Are Pilates Exercises Effective in Improving Postural Misalignment? Systematic Review and Metanalysis

ABSTRACT Introduction Pilates is commonly used to treat postural misalignments; however, there is a lack of systematic reviews on this topic. Objective To verify the effects of Pilates on postural misalignment. Methods A search (25 February 2024) was conducted in PubMed, EMBASE, CENTRAL, CINAHL, Web of Science, LILACS, SportDiscus, and PEDro. The methodological quality was assessed via the PEDro scale, and the certainty of evidence via the GRADE system. The meta‐analysis was conducted using the standardised mean difference (SMD). Results Eighteen studies were included in the systematic review. Eight studies had a low risk of bias. In children and adolescents, there was moderate certainty of evidence that Pilates improves postural alignment of the thoracic angle (SMD = −0.45 [0.67, −0.23]) and lumbar angle (SMD = −0.29 [–0.50, −0.07]) compared with inactive controls, whereas there was very low certainty of evidence that the Schroth technique is superior to Pilates for scoliosis (SMD = 0.98 [0.32, 1.65]). In adults, very low‐ to low‐certainty evidence has indicated that Pilates improves postural alignment of the shoulder angle (SMD = −0.78 [–1.23, −0.33]), scoliosis (SMD = −0.52 [–1.01, −0.04]) and lumbar lordosis (SMD = −0.40 [0.72, −0.08]) compared with inactive controls and improve the craniovertebral angle (SMD = −1.24 [–2.85, −0.38]) compared with stretching and strengthening exercises. Conclusion Pilates has some potential for improving postural misalignment of the thoracic and lumbar angles in children and adolescents. However, for other body segments, due to the low certainty of the evidence, further studies are needed.