The effects of pilates method in pregnant women: scoping review

Abstract

Background

Pregnancy induces physiological and psychological changes that require adaptation. Pilates, combining aerobic, strength, and flexibility exercises, is considered a safe and effective method to improve maternal and fetal outcomes. While studies highlight its benefits, a scoping review addressing the comprehensive effects of Pilates during pregnancy is lacking. This study aimed to comprehensively review the effects of Pilates during pregnancy, focusing on type, duration, frequency, practitioners, and parameters it influences.

Methods

A scoping review was conducted following Arksey and O’Malley’s framework and PRISMA-ScR guidelines. Six databases (PubMed, Scopus, Web of Science, PEDro, Cochrane Library, and CINAHL) were searched using MeSH terms. Studies published between January 2014 and September 2024 were included. Twenty-one studies meeting the inclusion criteria were analyzed for type, duration, frequency, practitioners, and outcomes.

Results

Most studies examined the effects of Pilates on sleep quality (n = 6), pain (n = 6), depression (n = 5), incontinence (n = 4), and disability (n = 4). Pilates showed significant effectiveness across these parameters. Traditional Pilates (n = 10) was the most commonly used method, followed by online, pregnancy-specific, and clinical Pilates. The exercise duration ranged from 4 to 16 weeks, with twice-weekly sessions being the most common. Practitioners were primarily Pilates instructors (n = 9) and physiotherapists (n = 6), with one study involving a midwife.

Conclusion

Pilates is effective for improving sleep quality, pain, depression, and other maternal health outcomes during pregnancy. Variations in method, frequency, and practitioners highlight the need for standardized protocols to optimize its benefits. This review provides insights for healthcare professionals to incorporate Pilates in prenatal care.

Background

Pregnancy is a natural physiological event, but the stress reactions it causes in the body are a process that affects all body systems and requires the physical, mental and social adaptation of the woman [1, 2]. Pregnant women minimize their physical activity levels with the thought that the pregnancy process and the fetus may be harmed [3]. Encouraging pregnant women to increase their physical activity levels may be important factors for improving maternal and fetal outcomes. Increased levels of physical activity during pregnancy are associated with a lower risk of emergency caesarean section, lower gestational weight gain, more favorable health assessment during pregnancy and gestational weight gain [4].

Pilates method, which is performed by exercise experts during pregnancy in accordance with the anatomy and physiology of pregnancy, is a safe method that does not cause complications for the mother and the fetus [5]. Pilates exercises combines aerobic, strength and flexibility components, aiming primarily to strengthen the core muscles and correct posture. Pilates during pregnancy has an effect on parameters such as labor pain, pregnancy-related low back pain, depression, fear of childbirth, birth experience, body composition, incontinence, birth outcomes, quality of life and general health status [5–13]. Different pilates methods are used in pregnancy, such as traditional, structured, online, clinical and pregnancy pilates [5, 10, 13–15]. Similarly, the effects of 4, 6, 8 and 12 weeks of exercises were examined at different frequencies of 1, 2 and 5 sessions per week [11, 13, 14, 16–19]. An another important issue is who performs the Pilates exercise. Pilates exercises are generally performed by physiotherapists or certified pilates instructors, while certified midwives also perform them [12, 18, 20].

In literature, there are different studies examining the effects of Pilates during pregnancy, but to our knowledge, there is no scoping review examining the effects of Pilates in pregnant women. Detailed examination of factors such as the type of Pilates, who performs the training, on which parameters it is effective, and application times is important. Therefore, this study aims to comprehensively review the literature from the last 10 years examining the effects of Pilates method during pregnancy.

Methods

Design

This study, which was conducted in a scoping review design, examined the findings of studies on the effects of Pilates exercises in pregnant women between January 1, 2004, and September 30, 2024. To conduct this review, Arksey and O’Malley’s 5-stage process for determining the scope of review studies was used [21]. The literature review was conducted between September 20, 2024, and September 30, 2024. The study protocol and manuscript followed the “Preferred Reporting Items for Systematic Reviews and Metaanalyses-extension for scoping reviews” criteria (PRISMA-ScR) [22].

Study questions

Four questions were identified for the study

1. Which type of Pilates method was used? Was Pilates performed alone or in combination with another intervention?

2. By whom was the application given?

3. On which parameters was its effect evaluated?

4. How many days a week, how many sessions and for how long in total?

Identifying related studies

“PubMed”, ‘Scopus’, ‘Web of Science’, ‘PEDro’, ‘Cochrane Library’ and ‘CINAHL’ electronic databases were used for literature search. The literature search was conducted in English. The following terms from the Medical Subject Headings (MeSH) were used to identify keywords: “pregnancy”, ‘pregnant’, ‘pilates’, ‘pilates method’, ‘pilates training’, ‘pilates exercise’ and Boolean operators ‘AND’ and ‘OR’, the search strategy for each database is shown in Table 1. To enhance search precision, we utilized Medical Subject Headings (MeSH) terms and field-specific filters in PubMed. Searches were refined using ‘Title/Abstract’ ([tiab]) filters to ensure relevant results. Boolean operators were systematically applied to combine related terms. The complete search strategies for each database, including MeSH terms, are provided in Table 1.

Table 1.

Search strategy for each data base

Data base	Search Strategy
Pubmed	(“Pregnancy“[MeSH] OR “Pregnant Women“[MeSH] OR “Prenatal Care“[MeSH] OR pregnancy[tiab] OR pregnant[tiab]) AND (“Pilates-Based Exercises“[MeSH] OR “Pilates Training“[MeSH] OR “Pilates Method“[MeSH] OR pilates[tiab] OR “Pilates exercise“[tiab]) Filters: from 2004/1/1–2024/9/30
Cochrane Library	(pregnancy OR pregnant) AND (Pilates OR “Pilates method” OR “Pilates training” OR “Pilates exercise”) Title/Abstract/Keywords, Date: 2004–2024
PEDro	“pregnancy” AND “Pilates” Clinical trials only, English, 2004–2024
Cinahl	(pregnancy OR pregnant) AND (Pilates OR “Pilates training” OR “Pilates exercise”) Limiters Date of publication: 2004/01/01–2024/09/30
Web of Science	((“pregnancy” OR pregnant) AND (“Pilates” OR “Pilates training” OR “Pilates exercise”)) (All Fields) Timespan: 2004-01-01 to 2024-09-30
Scopus	TITLE-ABS-KEY((“pregnancy” OR pregnant) AND (“Pilates” OR “Pilates training” OR “Pilates exercise”)) AND PUBYEAR > 2003 AND PUBYEAR < 2024

Study selection

The inclusion and exclusion criteria were explicitly aligned with the PICOS framework. Studies were included if they focused on pregnant women (Population), examined any form of Pilates as an intervention (Intervention), had either a control group or a comparison group (Comparison), measured at least one maternal health-related outcome (Outcome), and followed a randomized controlled, non-randomized controlled, or quasi-experimental design (Study Design). Studies that did not meet these criteria were excluded.

Inclusion criteria: Randomized or non-randomized controlled studies that directly discuss the results of Pilates methods in healthy pregnant women in the 2nd 3rd trimester of pregnancy, and original studies published in the last 10 years with full text available in English written in the style of before and after Pilates intervention. Only studies that included pregnant participants were considered for inclusion. Studies involving non-pregnant individuals or those examining Pilates in a general population were excluded. Exclusion criteria were case reports, case series, systematic reviews, meta-analyses, and non-English studies for which full text was not available. Both randomized and non-randomized controlled studies were included. Studies without a control group were excluded to minimize heterogeneity in outcome assessment.

All stages of study selection were carried out using the Rayyan program as a tool for the organization and management of the studies obtained. Study selection was carried out in 2 stages according to the protocol outlined by Arksey and O’Malley [21]: (1) Titles and abstracts were reviewed and screened for inclusion by 2 reviewers (AT and FYF). (2) Articles selected for full-text review were independently assessed by 2 experienced reviewers (HG and SO). They met to discuss inconsistencies and reach consensus on articles for inclusion.

Data extraction, synthesis and analysis

Two authors (HG and BSU) prepared the data table before the study. General descriptive information about the studies was provided, including authors, year and country of publication, study design, participant information, exercise duration, implementer, and outcomes. Any discrepancies were resolved through discussion or consultation with a third reviewer (SO).

To handle heterogeneity across studies, a narrative synthesis approach was employed. Studies were grouped based on the type of Pilates intervention (traditional, clinical, online, pregnancy-specific), duration (short-term ≤ 8 weeks vs. long-term > 8 weeks), and frequency (once vs. multiple sessions per week). The results were synthesized by identifying patterns and trends across studies, rather than performing a meta-analysis. Additionally, intervention effectiveness was analyzed within subgroups (e.g., impact on pain, sleep, depression, and quality of life) to better integrate findings across different study designs.

Quality assessment

To assess the methodological quality of included randomized controlled trials (RCTs), we used the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Each study was evaluated based on methodological domains, including randomization, blinding, allocation concealment, follow-up completion, and statistical analysis. Studies were classified as high, moderate, or low quality based on the number of positive criteria met (Table 2).

Table 2.

JBI critical appraisal checklist for RCTs and Quasi-Experimental studies

Study	Design	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	Overall Quality
Yıldırım et al., 2022	RCT	☑	?	☑	☒	☒	☒	☑	☑	☑	☑	Moderate
Ghandali et al., 2021	RCT	☑	?	☑	☒	☒	☒	☑	☑	☑	☑	Moderate
Batool et al., 2023	RCT	☑	☒	☒	☒	☒	☒	☑	☑	☑	☑	Low
Manca et al., 2024	Quasi-Exp.	☒	☒	☑	☒	☒	☒	☑	☑	☑	☑	Moderate
Aktan et al., 2021	RCT	☑	☑	☑	☑	☑	☑	☑	☑	☑	☑	High
Bulguroglu et al., 2024	RCT	☑	☑	☑	☑	☒	☒	☑	☑	☑	☑	High
Buran & Erim, 2024	RCT	☑	☑	☑	☑	☑	☑	☑	☑	☑	☑	High
Feria-Ramírez et al., 2021	Quasi-Exp.	☒	☒	☑	☒	☒	☒	☑	☑	☑	☑	Moderate
Güder, 2019	Quasi-Exp.	☒	☒	☑	☒	☒	☒	☑	☑	☑	☑	Moderate
Güder et al., 2018	Quasi-Exp.	☒	☒	☑	☒	☒	☒	☑	☑	☑	☑	Moderate
Hyun & Jeon, 2020	RCT	☑	?	☑	☒	☒	☒	☑	☑	☑	☑	Moderate
Hyun et al., 2022	Quasi-Exp.	☒	☒	☑	☒	☒	☒	☑	☑	☑	☑	Moderate
Jeralic et al., 2022	Quasi-Exp.	☒	☒	☑	☒	☒	☒	☑	☑	☑	☑	Moderate
Kim & Hyun, 2022	RCT	☑	☑	☑	☑	☑	☑	☑	☑	☑	☑	High
Urer et al., 2023	RCT	☑	☑	☑	☑	☑	☑	☑	☑	☑	☑	High
Oktaviani, 2018	RCT	☑	?	☑	☒	☒	☒	☑	☑	☑	☑	Moderate
Sonmezer et al., 2021	RCT	☑	☑	☑	☑	☑	☑	☑	☑	☑	☑	High
Nascimento et al., 2021	RCT	☑	☑	☑	☑	☑	☑	☑	☑	☑	☑	High
Pavithralochani et al., 2019	RCT	☑	☑	☑	☑	☑	☑	☑	☑	☑	☑	High
Dias et al., 2018	RCT	☑	☑	☑	☑	☑	☑	☑	☑	☑	☑	High
Mazzarino et al., 2022	RCT	☑	☑	☑	☑	☑	☑	☑	☑	☑	☑	High

Q1: Randomization?, Q2: Allocation Concealment?, Q3: Groups Similar at Baseline?, Q4: Participants Blinded?, Q5: Personnel Blinded?, Q6: Outcome Assessors Blinded?, Q7: Groups Treated Similarly?, Q8: Follow-up Complete?, Q9: Outcome Measures Reliable?, Q10: Statistical Analysis Appropriate?, RCT: randomized controlled trials, Quasi-Exp.: quasi-experimental, ☑: Yes, ☒: No,?: unclear/not applicable

Results

Electronic databases were searched, and 327 studies were available. After eliminating 168 duplicate studies, 159 of the remaining 127 studies were excluded by title and abstract review. Full texts of thirty-two studies were reviewed and 11 of them were excluded because they did not meet the inclusion criteria. Finally, the remaining 21 studies were included in the review (Fig. 1).

Fig. 1.

Flowchart of studies included in the scoping review (Preferred Reporting Items for Systematic Reviews and Meta analyses - extension for scoping reviews)

The majority of the studies conducted between 2004 and 2024 were in Türkiye with six studies, 3 studies in South Korea, 2 studies in Brazil and Northern Cyprus, 1 study in Iran, Italy, Pakistan, Spain, Slovenia, Indonesia, India and Australia.

Outcome measures and findings

The studies included in this review mostly examined the effect of pilates on sleep quality [6, 10, 12, 13, 23, 24] and pain [5, 11–14, 20]. Five of these studies reported that Pilates was effective on sleep quality [6, 10, 12, 23, 24]. All reported that it was effective on pain [5, 11–14, 20].

Five studies examined the effect of Pilates on depression and all reported that it was effective on depression [6, 7, 10, 13, 24].

Four of the included studies examined the effect of Pilates on disability [10, 12, 13, 23] and incontinence [11, 15, 19, 25]. Three studies reported that Pilates was effective on disability [12, 13, 23] and four studies reported that Pilates was effective on incontinence [11, 15, 19, 25].

Three studies examined the effect of Pilates on muscle strength and reported that Pilates was effective on muscle strength in these studies [9, 16, 23].

Two studies examined the effect of Pilates on stress [9, 24], satisfaction [5, 8], anxiety [7, 14], fear of childbirth [7, 26], pelvic stabilization [9, 12] and reported that Pilates was effective on these parameters. Two studies examined the effect of Pilates on quality of life [12, 18] and one study reported that Pilates was effective on quality of life [12].

The effects of Pilates on perineal trauma [17], birth plans [8], vital signs [27], sexual function [11], blood lipids and body composition [24] were analyzed in one study and Pilates was reported to be effective on these parameters (Table 3).

Table 3.

Selected studies

Author and Country	Pilates method	Study design	Sample	Outcome Measures	Findings
Yildirim et al., 2022 Türkiye (13)	Intervention: Pilates-based therapeutic exercise, twice a week for 60-min per session for 12 weeks Control: Usual prenatal care Instructor: Pilates instructor	Randomized controlled trial	34 women in the second trimester of pregnancy Pilates (n = 17) Control (n = 17)	Disability: Roland-Morris Disability Questionnaire, LPP: Visual Analog Scale (VAS), Mood: Hospital Anxiety and Depression Scale, Anxiety (HADS-A) and Depression (HADS-D) subscales, Sleep quality: Pittsburgh Sleep Quality Index (PSQI)	There was a statistically significant difference in disability, pain, and mood in favor of the Pilates group (p < 0.001). There was no significant difference between the two groups in terms of the PSQI (p = 0.670)
Ghandali et al.,2021 Iran (5)	Intervention: Structured- Pilates twice a week for 8 weeks Control: did not do any exercise Instructor: Pilates instructor	Randomized controlled trial	110 primiparous women Intervention (n = 55) Control (n = 55)	Labor pain: VAS Maternal satisfaction: Mackey Childbirth Satisfaction Rating Scale	Pilates significantly reduces the labor pain intensity, length of the active phase and second stage of labor and increases maternal satisfaction of the labor process (p < 0.05). length of labor was shorter in Pilates exercise group than in the control group (p = 0.004). There was no statistically significant difference between the two groups in terms of Episiotomy, type of delivery, first and fifth Apgar score of neonates (p > 0.05).
Batool et al. 2023, Pakistan (6)	Intervention:: Traditional Pilates, 8 weeks Control: Aerobic exercise Instructor: No information available .	Randomized trial	38 primigravida women Aerobic (n = 19) Pilates (n = 19)	Depression: Center for Epidemiologic Studies Depression Scale (CES-D Scale) Sleep quality: Pittsburgh Sleep Quality Index (PSQI)	Improvement in CES-D scale and PSQI were observed in both groups as p value was significant p < 0.05. Between the groups significant improvement was seen in CES-D and Quality of Sleep in Pilates training group as p < 0.05.
Manca et al., 2024, Italy (10)	Intervention: Online Pilates, 2 times 1 h before pregnancy 4 sessions of Mat Pilates in the second trimester 1 in 4 weeks in the last trimester Control: none Instructor: Pilates, Yoga and Lagree certified instructor	Single group pre-post intervention trial	136 pregnant women	Low back pain (LBP): Oswestry Disability Index (ODI) Sleep quality: Pittsburgh Sleep Quality Index (PSQI) Mood changes and depression: Edinburgh Postnatal Depression Scale (EPDS) Psychological status: General Health Questionnaire (GHQ-28)	In the prenatal period, significant weight gains were observed only in low and moderate exercisers. In contrast to low (p < 0.001) and moderate exercisers (p < 0.001), only high exercisers did not show a significant increase in LBP-related disability (p = 0.210). Sleep disturbances were significantly increased in low p = 0.005), moderate (p = 0.500) and high exercisers (p = 0.910). Regardless of the amount of exercise, depression scores improved in all groups. Following the postnatal intervention (n = 40), only those who exercised moderate amounts showed significant reductions in sleep disturbances (p = 0.003) and depression (p = 0.040).
Aktan et al., 2021, Türkiye (14)	Intervention: Clinical Pilates, 1 h, 2 days a week for 8 weeks, and childbirth training applied one day a week for 4 weeks Control: Childbirth training Instructor: Physiotherapist	Randomized trial	64 pregnant women Group 1 (childbirth training with clinical Pilates) (n = 21) Group 2 (Childbirth training) (n = 21) Control (n = 22)	Pain: VAS Anxiety: State-Trait Anxiety Inventory	Pilates group had better general anxiety values, gained less weight and felt less pain during labor than the other groups (p < 0 0.05). No difference was observed between the groups in terms of the duration of labor, gestational age, or infant birth weight (p > 0.05 for all). TheAPGAR scores of the infants of the Pilates group were better than those of the other groups (p < 0.05).
Bulguroglu and Bulguroglu, 2024, Türkiye (7)	Intervention: Online Pilates, 1 h, 1days a week for 8 weeks Control: Home program Instructor: Physiotherapist	Randomized controlled trial	53 primiparous women Online Pilates group (n = 27) Control group (n = 26)	Depression: EPDS Anxiety: State-Trait Anxiety Inventory Fear of childbirth: Wijma Birth Expectation/Experience Questionnaire Version A (W-DEQ-A)	Online Pilates training effectively reduced depression (p = 0.041), state anxiety (p = 0.037), trait anxiety (p = 0.024) and fear of childbirth (p = 0.023) compared to the control group.
Buran and Erim, 2024, Türkiye (15)	Intervention: Pregnancy Pilates, twice in a week for 8 weeks Control: Routine obstetric and pregnancy care Instructor: Pregnancy Pilates certificated instructor	Randomized controlled trial	126 nulliparous women Experimental group (n = 63) Control group (n = 63)	Incontinence: Michigan Incontinence Severity Index Form (MISI)	the experimental group during pregnancy was significantly lower than the control group. The experimental group had almost twice the rate of vaginal birth than those of the control group. The duration of labor mean score of experimental group was five hours and 43 min less than the duration of labor of the control group (p < 0.001). After intervention, and postpartum period, The stress urinary incontinence and urge urinary incontinence severity of the experimental group was significantly lower than those of the control group (p < 0.001).
Feria-Ramírez et al., 2021, Spain (17)	Intervention: Traditional Pilates, one-hour twice in a week for 4 weeks Control: antenatal classes Instructor: No information available	Quasi-Experimental	72 pregnant women Pilates group (n = 48) Control group (n = 24)	Participant data form	The results indicate that this proportion was lower among those women who underwent an episiotomy, with laceration occurring in 9.7% of the cases, as opposed to 65.9% in the case of those who did not undergo the procedure (OR, 0.06; 95% CI, 0.01–0.21). Likewise, participation in the Pilates sessions was demonstrated to be effective, with this complication occurring in the majority of cases (86.7%) among the women receiving solely the usual antenatal classes (OR, 0.17; 95% CI, 0.05–0.57) (Table 3) and laceration occurring with a frequency of 54.2% in this group, in contrast to 16.7% among those who received the Pilates sessions (p = 0.006).
Guder et al., 2019, Northern Cyprus (8)	Intervention: Pregnancy Pilates, 45 min, twice a week for two hours of eight weeks Control: Routine antenatal check-up Instructor: Pilates instructor	quasi-experimental/non-randomized trials	70 primiparous women Experimental group (n = 35) Control group (n = 35)	Introductory form Data collection form investigating birth plans and process	The experimental group had a lower rate of planned cesarean, were more satisfied with their childbirth experiences, received more support during the birthing process, and used more techniques for coping with pain during labor (p < 0.05). The experimental group was earlier to have contact with their infants, to the first breast feed their infants (p < 0.05).
Guder et al., 2018, Northern Cyprus (26)	Intervention: Pregnancy Pilates, 45 min, twice a week for two hours of eight weeks Control: Routine antenatal check-up Instructor: Pilates instructor	quasi-experimental/non-randomized trials	108 primiparous women Experimental group (n = 54) Control group (n = 54)	Personal information from Fear of childbirth: W-DEQ A The birth outcomes data collection form	The study found that the experimental group had a moderate level of childbirth fear prior to the training and a low level of childbirth fear following the training (p < 0.05). The study was determined that the experimental group, as compared to the control group, was positively affected by the training, in terms of childbirth fear, mode of the birth, planned or unplanned cesarean birth, the Apgar score and body weight of the newborn, and problems in the development of the newborn, the first contact time with newborn, and the first time breastfeeding (p < 0.05). The childbirth preparation program had a positive effect on fear of childbirth and neonatal outcomes (p < 0.05).
Hyun and Jeon, 2020, South Korea (9)	Intervention: Traditional Pilates, twice a week, 60 min per day, total 12 weeks Control: none Instructor: No information available	cluster-randomized controlled experiment.	16 pregnant women Pilates group (n = 9) Control group (n = 7)	Pelvic Stabilization Muscle Strength Test Body Composition Biochemical Analyses	Pilates exercises had positive effect on body water balance and strengthens the muscles related to pelvic stabilization within the range of reducing muscle damage or causing muscle damage and stress in pregnant women (p < 0.05).
Hyun et al., 2022, South Korea (23)	Intervention: Home-based tele-Pilates, 50 min/day, 2 days/week 8 week Control: non-Pilates exercise Instructor: No information available	cluster randomized controlled experiment pilot study	14 pregnant women Pilates group (n = 7) Control group (n = 7)	body composition, muscles of the hip joint, pelvic tilt Disability: ODI Sleep quality: PSQI	Pilates is an effective exercise for pregnant woman that reduces body fat metabolism and strengthens muscles of the hip joint, thus alleviating pregnancy-induced low back pain and insomnia (p < 0.05).
Jeralic et al., 2022, Slovenia (27)	Intervention: Combined Pilates, Yoga and aerobic, 60–75 min per week 16 week Control: Yoga Instructor: Pilates instructor	An quasi-experimental pilot study	31 pregnant women	A health questionnaire	Comparing pre and post exercise measurements, statistically significant differences were found in post exercise body temperature (p = 0.005) and systolic blood pressure (p = 0.007) compared with preexercise measurements. When comparing the results between yoga and Pilates exercise sessions, no statistically significant differences were found. When comparing results related to pre-pregnancy physical activity, significant differences in pre-exercise saturation were found (p = 0.041).
Kim et al., 2022 South Kore (24)	Intervention: Online Pilates, 8 weeks, twice a week for 50 min a day Control: non-exercise Instructor: Pilates instructor	A Randomized Pilot Study	16 pregnant women Pilates group (n = 8) Control group (n = 8)	Body Composition Test Blood test Depression: EPDS Sleep quality: PSQI Stress: Perceived Stress Scale (PSS)	The weight, percentage of body fat, body fat mass, and BMI of the Pilates group decreased (p < 0.05). Blood lipids showed significant differences between the groups in TC, TG, LDL and CRP, while insulin and HDL showed no difference. All blood lipids, insulin, and CRP in the Pilates group were reduced (p < 0.05). There were significant differences between the groups in postpartum depression, sleep disorders, and perceived stress indices performed in the post-test, and the serotonin concentration in the Pilates group increased (p < 0.05). Serotonin levels were significantly correlated with postpartum depression, body fat mass, and body fat rate (p < 0.05).
Urer et al., 2023, Turkey (25)	Intervention: Traditional Pilates, 12th week of pregnancy until the birth, 2 h two days a week Control: did not do pilates Instructor:No information available	retrospective case-control study	142 pregnant women	Incontinence severity: Michigan Incontinence Symptom Index	Postpartum SUI occurred in 39.4% of the women. The severity score of women who practised Pilates was found to be statistically significantly lower than those who did not practise Pilates.
Oktaviani, 2018, Indonesia (20)	Intervention: Traditional Pilates, 70–80 min per day, once a week, for 8 weeks Control: Standard pregnancy exercise Instructor: Pilates instructor	experimental study	40 pregnant women Pilates group (n = 20) Control group (n = 20)	Pain: VAS	The reduction in the level of pain was found to be significantly greater in the group of pregnant women who completed the Pilates workout (p < 0.05).
Sonmezer et al.,2020, Türkiye (12)	Intervention: Clinical Pilates, 60–70 min twice a week for 8 weeks Control: Regular prenatal care Instructor: Physiotherapist	Randomized controlled trial	40 pregnant women Pilates group (n = 20) Control group (n = 20)	Lumbopelvic stabilization: pressure biofeedback Pain: VAS Disability: ODI Quality of life: Nottingham Health Profile	Pain and disability were significantly improved in the Pilates exercise group after intervention (p = 0.03, p < 0.001, respectively). There were also significant improvements in sleep, physical mobility sub-parameters of NHP and lumbopelvic stabilization after Pilates exercises (p = 0.048, p = 0.007, respectively). However, there were no statistically significant changes in all outcome measures in the control group (p > 0.05).
Nascimento et al., 2021 Brazil (11)	Intervention: Traditional Pilates, 55–60 min per day, twice a week, for 12 weeks Control: Conventional treatment Instructor: Physiotherapist	Randomized controlled trial	25 pregnant women with GDM Pilates group (n = 13) Control group (n = 12)	Urinary symptoms: Short-Form International Consultation on Incontinence Questionnaire Sexual function: Female Sexual Function Index Pain: VAS	Pilates training improved fasting glucose, maternal weight gain, and urinary incontinence score as compared with the group submitted exclusively to conventional therapy (p < 0.05).
Pavithralochani et al., 2019 India (19)	Intervention: Traditional Pilates, 20 min per day, twice a day, 5 sessions for a week, for 12 weeks Control: Kegel exercises Instructor: Physiotherapist	Randomized controlled trial	30 pregnant women Pilates group (n = 15) Control group (n = 15)	Urinary Incontinence Diagnostic Questionnaire (QUID) Urogenital Distress Inventory Short Form (UDI-6)	The frequency of urinary incontinence decreased in both groups (p < 0.05). However, there was a significant decrease in urinary incontinence in subjects who performed Pilates exercise compared to those who performed Kegel exercise (p < 0.05).
Dias et al., 2017 Brazil (16)	Intervention: Traditional Pilates, twice-weekly sessions of 1 h each during the period between the 14-16th and32-34th gestational week Control: walking, and strengthening exercises Instructor: Physiotherapist	Randomized controlled trial	50 primiparous w Pilates (n = 25) Control (n = 25)	PFM strength: manometer, PFM endurance and repeatability: Oxford Scale	There were no differences between the groups for manometry (p > 0.05). An increase in the PFM strength, endurance, and repeatability was only observed in the Pilates group (p < 0.05). In addition, the Pilates group showed greater adherence to the intervention (p < 0.05).
Mazzarino et al.,2021 Australia (18)	Intervention: Traditional Pilates, Once a week for 6 weeks Control: Usual antenatal care Instructor: Midwife certified as a Polestar® Pilates rehabilitation practitioner	Single blind Randomized controlled trial	30 pregnant women Pilates group (n = 15) Control group (n = 15)	Quality of life: 12-item short form survey Lower extremity performance: wall squat test, sit to stand test, single calf raise test	No significant difference was found between the groups in terms of pain, mobility, abdominal separation, urinary continence, analgesia or mode of delivery (p > 0.05).

Type of pilates method

Ten of the included studies performed traditional Pilates [9, 11, 13, 16–20, 25, 27]. Four studies reported performing the online or tele-Pilates method [7, 10, 23, 24]. Three studies reported performing the pregnancy Pilates [8, 15, 26]. Two studies reported performing the clinical Pilates [12, 14]. One study reported that structured Pilates [5] was performed, while no information was given about the Pilates method in another study [6] (Table 3).

Duration

Eleven of the included studies reported 8 weeks of Pilates [5–8, 12, 14, 15, 20, 23, 24, 26]. Four studies reported 12 weeks of Pilates [9, 11, 13, 25]. Three studies reported 4 weeks of Pilates [16, 17, 19]. Two studies reported 6 weeks [10, 18] and one study reported 16 weeks of Pilates [27]. Fourteen studies reported twice a week Pilates [5, 8–16, 23–26], three studies reported once a week pilates [7, 18, 20] (Table 3).

Practitioner

Pilates in the 9 of the included studies were performed by Pilates instructors [5, 8, 10, 13, 15, 20, 24, 26, 27], 6 by physiotherapists [7, 11, 12, 14, 16, 19] and one by a midwife [18]. Other studies did not provide information about the practitioner (Table 3).

Discussion

This scoping review comprehensively analyzed the effects of Pilates exercises on pregnant women and demonstrated its positive impact on various health parameters, including pain management, sleep quality, mental health, urinary incontinence, pelvic floor function, and birth outcomes. The findings strongly support the integration of Pilates into antenatal care programs as a safe and effective intervention for enhancing maternal health.

Pregnancy-related lumbopelvic pain (LPP) is one of the most common physical complaints among pregnant women. This review found that Pilates significantly reduces pain intensity and improves functional disability, as reported in multiple studies [12, 13, 20]. Sonmezer et al. (2021) demonstrated that clinical Pilates reduced LPP and functional disability scores (measured by the Oswestry Disability Index) over an 8-week intervention supervised by a physiotherapist. Similarly, Yildirim et al. (2022) reported significant improvements in pain levels and daily function following a 12-week traditional Pilates program. These results can be attributed to the strengthening of core muscles and improved pelvic stabilization, which are fundamental benefits of Pilates exercises. However, differences in intervention duration, session frequency, and Pilates methodology across studies may have influenced the reported outcomes. For instance, while some studies implemented short-term interventions lasting only four weeks [16, 17, 19], others applied longer durations up to 16 weeks [27]. Similarly, variations in session frequency, ranging from once to three times per week, could have impacted the observed benefits [12, 13, 15]. Additionally, the type of Pilates performed—traditional mat-based, reformer-assisted, or pregnancy-adapted Pilates—introduces another layer of variability that should be considered when interpreting findings.

Sleep disturbances are a prevalent issue during pregnancy, exacerbated by hormonal changes, physical discomfort, and psychological stress. The current review found consistent evidence that Pilates improves sleep quality, as demonstrated by studies utilizing the Pittsburgh Sleep Quality Index [6, 10, 24]. Batool et al. (2023) reported that Pilates led to greater improvements in sleep quality compared to aerobic exercises, emphasizing its role as a low-impact intervention suitable for pregnant women. Similarly, Manca et al. (2024) showed that an 8-week online Pilates program effectively reduced sleep disturbances across exercise intensity levels, further supporting its accessibility and flexibility.

Pregnancy often brings significant psychological challenges, including depression, anxiety, and fear of childbirth. Pilates has been shown to positively impact mental health outcomes, reducing symptoms of depression and anxiety while alleviating childbirth-related fears [5, 7, 10]. For instance, Bulguroglu et al. (2024) reported that online Pilates programs reduced depression and state-trait anxiety scores, highlighting its feasibility during times of limited in-person access, such as the COVID-19 pandemic. Additionally, Ghandali et al. (2021) noted significant reductions in labor-related anxiety and improved maternal satisfaction in women practicing structured Pilates. These findings underline the dual benefit of Pilates for both mental resilience and childbirth preparation.

This review further demonstrated the role of Pilates in improving pelvic floor muscle function and managing urinary incontinence during and after pregnancy [15, 19, 25]. Buran and Erim (2024) found that Pilates-assisted childbirth training significantly reduced the severity of stress urinary incontinence (SUI) during pregnancy and postpartum. Similarly, Pavithralochani et al. (2019) compared Pilates to Kegel exercises and reported superior outcomes in pelvic floor muscle strength and urinary incontinence severity in the Pilates group. These findings suggest that Pilates effectively integrates pelvic floor contractions, contributing to core stability and functional recovery. One potential explanation for this effect is the co-activation of the transversus abdominis and pelvic floor muscles during Pilates exercises, which enhances intra-abdominal pressure control and supports bladder function (Theodorsen 2019). This hypothesis is supported by studies demonstrating increased pelvic floor electromyographic activity during Pilates-based interventions. Future research should further explore these neuromuscular adaptations through imaging and pressure biofeedback techniques [28].

Pilates has also been associated with favorable labor outcomes, including reduced labor pain, shorter labor duration, and increased maternal satisfaction [5, 14, 17]. Ghandali et al. (2021) observed that Pilates significantly shortened the active and second stages of labor, while also reducing perceived labor pain intensity. Similarly, Aktan et al. (2021) demonstrated that clinical Pilates, combined with childbirth training, improved maternal satisfaction and decreased anxiety levels during labor. These findings underscore the importance of Pilates as a preparatory intervention for improving childbirth experiences. Nonetheless, it is crucial to recognize that the variability in study designs, sample sizes, and intervention protocols might have contributed to differences in reported labor-related outcomes.

It is noteworthy that some studies did not find statistically significant improvements in certain health outcomes, such as sleep quality or quality of life [13, 18]. These discrepancies may be attributed to several factors: the diversity in Pilates protocols (e.g., mat-based vs. clinical Pilates), session frequency and duration, and participant adherence to the program. Psychological baseline differences, such as pre-existing anxiety or depression levels, may also mediate the effect of Pilates. Moreover, the qualifications of the instructor (e.g., certified physiotherapist vs. general instructor) may influence the precision of technique and safety, potentially affecting outcomes [5, 11–14, 16].

The effectiveness of Pilates interventions appears to depend on their duration, frequency, and supervision. This review found that interventions lasting 8 to 12 weeks, conducted 2–3 times per week for 50–70 min per session, yielded the most significant improvements across physical and mental health outcomes [12, 13, 15]. Moreover, studies supervised by physiotherapists or certified Pilates instructors demonstrated superior results, suggesting that practitioner expertise may be a key factor in ensuring program effectiveness [11, 16, 20].

Given the variation in outcomes across studies, we recommend that prenatal Pilates programs be delivered under the supervision of qualified professionals—preferably physiotherapists or certified Pilates instructors with experience in obstetric care. Furthermore, individualized exercise plans that consider the gestational week, maternal fitness level, and mental health status are advised to enhance adherence, safety, and overall effectiveness. These considerations may improve clinical implementation and standardization across prenatal care settings.

Study limitations

Despite the promising findings, several limitations must be acknowledged. The heterogeneity in study designs, intervention protocols, and outcome measures limits direct comparisons and generalizability. Additionally, most studies had small sample sizes and lacked long-term follow-up data. A key limitation is the lack of direct comparisons between Pilates and other prenatal exercises, such as resistance training, aerobic exercise, and yoga. Future research should include randomized controlled trials to determine whether Pilates offers distinct advantages or is comparable to these interventions. Future research should prioritize large-scale, randomized controlled trials (RCTs) with standardized protocols to explore the long-term effects of Pilates on postpartum recovery and maternal health, while also examining its cost-effectiveness and accessibility, particularly in low-resource settings, along with its psychological and social dimensions, including its impact on maternal mental health and quality of life, to support its integration into routine antenatal care. The strengths of this study were that it provided a comprehensive review of Pilates during pregnancy by synthesizing findings from multiple databases and including studies published in the last decade, and ensuring reliability and transparency using a rigorous methodology based on Arksey and O’Malley’s framework and PRISMA-ScR guidelines.

Conclusion

While current evidence suggests that Pilates holds promise as a prenatal exercise intervention, variations in study methodologies and the lack of standardized protocols limit its definitive endorsement as superior to other exercise modalities. Future research should prioritize rigorous trial designs and mechanistic investigations to fully elucidate the role of Pilates in prenatal health and establish its place within broader clinical recommendations.

Author contributions

H.G.: Conceptualization, Methodology, Writing- Original draft preparation, Investigation. A.T.: Data curation, Investigation, Writing- Original draft preparation. B.S.U.: Methodology, Writing- Original draft preparation, Investigation, F.Y.F.: Data curation, Investigation, Writing- Original draft preparation.S.O.: Visualization, Supervision, Reviewing and Editing.

Funding

Authors did not receive funding to carry out this research.

Data availability

Data can be provided by the corresponding author upon request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.