OBJECTIVE: To investigate the effectiveness of the addition of modified Pilates exercises to minimal intervention in patients with chronic low back pain. DESIGN: Randomized controlled trial. SETTING: Outpatient physical therapy department in Brazil. PATIENTS: Eighty-six patients with chronic non-specific low back pain. INTERVENTIONS: All patients received an education booklet containing information about low back pain and were randomly allocated to receive 12 sessions of exercises based upon the Pilates principles over six weeks (n = 43) or not (ie, education alone) (n = 43). MEASUREMENTS: Primary outcomes were pain intensity and disability measured at six weeks and six months. Secondary outcomes were: patient-specific functional disability, global impression of recovery and kinesiophobia measured at six weeks and six months. All outcomes were measured by a blinded assessor in all time points. RESULTS: There was no loss to follow-up in any of the time-points. We observed improvements in pain (mean difference 2.2 points; 95% CI 1.1 to 3.2), disability (mean difference 2.7 points; 95% CI 1.0 to 4.4), and global impression of recovery (mean difference -1.5 points; 95% CI -2.6 to -0.4) in favor of the Pilates group after intervention, but these differences were no longer statistically significant at six months. LIMITATIONS: Treatment provider and patients could not be blinded to the interventions. CONCLUSIONS: The addition of modified-Pilates exercises to an educational booklet provides small benefits compared to education alone in patients with chronic non-specific low back pain; however, these effects were not sustained over time.

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