Cardiorespiratory fitness has been postulated as an independent predictor of several chronic diseases. We aimed to estimate the effect of Pilates on improving cardiorespiratory fitness and to explore whether this effect could be modified by a participant's health condition or by baseline VO2max levels. We searched databases from inception to September 2019. Data were pooled using a random effects model. The Cochrane risk of bias (RoB 2.0) tool and the Quality Assessment Tool for Quantitative Studies were performed. The primary outcome was cardiorespiratory fitness measured by VO2max. The search identified 527 potential studies of which 10 studies were included in the systematic review and 9 in the meta-analysis. The meta-analysis showed that Pilates increased VO2max, with an effect size (ES) 0.57 (95% CI 0.15 to 1; I2 = 63.5%, p = 0.018) for the Pilates group versus the control and ES 0.51 (95% CI 0.26 to 0.76; I2 = 67%, p = 0.002) for Pilates pre-post effect. The estimates of the pooled ES were similar in both sensitivity and subgroup analyses; however, random-effects meta-regressions based on baseline VO2max were significant. Pilates improves cardiorespiratory fitness regardless of the population's health status. Therefore, it may be an efficacious alternative for both the healthy population and patients suffering from specific disorders to achieve evidenced-based results from cardiorespiratory and neuromotor exercises.

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