Pilates during pregnancy for maternal musculoskeletal pain and discomfort: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Pain: p=0.001; Disability: p=0.002

• Effect Size: Pain reduction: MD=-2.59; Disability reduction: SMD=-1.82

• Primary Outcome: Musculoskeletal pain intensity (VAS 0-10) and pregnancy-related disability

• Nnt Or Sensitivity: Clinically meaningful pain reduction of 2.6 points on 10-point VAS scale

• Confidence Interval: Pain: 95% CI -4.19 to -1.00; Disability: 95% CI -2.99 to -0.66

Clinical Application

Pilates requires trained instructors and may not be accessible in all settings; safety considerations for pregnancy modifications essential Aligns with RANZCOG guidelines supporting safe exercise in pregnancy; potential Medicare rebates through allied health programs; physiotherapist-led Pilates may qualify for private health insurance coverage Pregnant women experiencing musculoskeletal pain, particularly back and pelvic pain

Abstract

OBJECTIVES: The predominant concern during pregnancy is musculoskeletal pain, often accompanied by additional discomforts such as anxiety and insomnia. Pilates, as a low-impact mind-body exercise, may be beneficial in managing musculoskeletal pain and associated symptoms in adults. This systematic review and meta-analysis aimed to synthesise the evidence on the effectiveness of Pilates for alleviating musculoskeletal pain and other discomforts during pregnancy. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Scopus, TRIP Medical Database, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to 14 January 2026. ELIGIBILITY CRITERIA: Randomised controlled trials and prospective non-randomised controlled studies that compared Pilates with other prenatal care modalities for improving musculoskeletal pain and discomfort were eligible. DATA EXTRACTION AND SYNTHESIS: Two researchers independently extracted data using standardised forms with subsequent cross-verification. Risk of bias was assessed using the Cochrane Risk of Bias V.2.0 tool. Meta-analyses were performed using random-effects models. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: 13 studies were included in the systematic review, of which 10 contributed data to the meta-analysis. Primary outcomes were pain intensity and disability level. Pain intensity was assessed using Visual Analogue Scale (range 0-10). Moderate-certainty evidence demonstrated that Pilates significantly reduced musculoskeletal pain during pregnancy (mean differences (MD)=-2.59, 95% CI -4.19 to -1.00; I²=91%, p=0.001). Low-certainty evidence suggested that Pilates reduced pregnancy-related disability (standardised mean differences (SMD)=-1.82, 95% CI -2.99 to -0.66; I² = 93%, p=0.002). Secondary outcomes comprised sleep quality and psychological status. Multivariate meta-analysis showed significant improvements in psychological status (SMD=-0.86, 95% CI -1.31 to -0.42; τ²=0.4, I²=86%, p=0.0005) but did not yield statistically significant improvements in sleep quality (MD=-1.93, 95% CI -4.70 to 0.84; I²=93%, p=0.17). Both secondary outcomes were supported by very low-certainty evidence. Risk of bias assessment rated three studies as high risk, three as unclear risk and seven as low risk. Formal assessment of publication bias was not feasible owing to the limited number of studies (fewer than 10 per outcome). CONCLUSION: This meta-analysis demonstrates that, compared with standard care, structured prenatal Pilates significantly alleviates musculoskeletal pain and disability while also enhancing psychological status. PROSPERO REGISTRATION NUMBER: CRD42024628027.

References

1. 1.Song, C., Shen, Y., Tang, X., Li, Z., Li, X., Zhang, X., Xiang, Y., Ma, J., Tian, X., Li, H., Li, F., & Li, H. (2026). Pilates during pregnancy for maternal musculoskeletal pain and discomfort: a systematic review and meta-analysis. BMJ Open. https://doi.org/10.1136/bmjopen-2025-112441