The Pilates Method as a Therapeutic Intervention in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis

Fibromyalgia is a chronic condition characterized by widespread pain, fatigue, and reduced quality of life. Exercise therapy, including Pilates, is commonly recommended; however, current reviews report inconsistent findings across specific modalities. This PRISMA 2020 systematic review and meta-analysis with a PROSPERO-registered protocol, designed as a focused update of post-2020 RCTs complementing prior comprehensive syntheses, evaluated Pilates-based interventions for pain and fibromyalgia impact (FIQ). HRQoL outcomes were synthesized narratively due to heterogeneity in measurement instruments, and all outcomes were extracted at the first post-intervention assessment (no pooled long-term data were available). Seven RCTs (6–12 weeks; 2–3 sessions/week) met eligibility criteria. Methodological quality was generally moderate (PEDro), and risk of bias was assessed using RoB 2. Certainty of evidence (GRADE) was rated very low for pain and low for FIQ. Among trials reporting adherence (4/7), values ranged from 68% to 92%; adverse event monitoring was inconsistent (systematically reported in 2/7), limiting tolerability conclusions. Between-group effects versus active comparators were small and non-significant for pain (pooled Hedges’ g = −0.10, 95% CI −0.83, 0.63, p = 0.79; I2 = 73%); this wide interval, spanning potential benefit to harm, precludes definitive conclusions. For FIQ, the primary (unadjusted) analysis was non-significant: pooled MD = −5.53 (95% CI −11.96, 0.89, p = 0.09); sensitivity analysis using ANCOVA-adjusted estimates yielded MD = −6.71 (95% CI −13.11, −0.30, p = 0.04). Both estimates remained below MCID thresholds and were sensitive to estimator choice. Absence of statistical significance does not demonstrate equivalence; non-inferiority designs with predefined margins would be required. Given very low (pain) to low (FIQ) certainty of evidence, adequately powered trials with standardized protocols and longer follow-up are needed to resolve uncertainty regarding Pilates’ comparative effectiveness within multimodal fibromyalgia management.