BACKGROUND: The main theme of this systematic review and meta-analysis is to synthesize the evidence of randomized controlled trial of evidence of Pilates intervention, in comparison to control groups and other forms of exercise, for falls prevention in healthy older adults. METHODS: The following electronic databases were searched up to October 2020; Embase, Scopus, Google Scholar, Medline (Ovid), ScienceDirect, Cochrane, and CINAHL. The recommendations of the Preferred Reporting Items of Systematic Reviews and Meta-Analyses were followed. A PICOS approach was adopted as a framework to formulate the research question and set the inclusion and exclusion criteria. Participants were healthy older adults, defined as older adults who have maintained functional ability, including participants of both genders, those with a falls history, non-fallers, and individuals who were considered to be sedentary or active. Randomized controlled trials studies, written in the English language, from the decade, were included if they focused on specific outcome measures to decrease falls risk; functional mobility, mobility, fear of falling, gait, and postural stability. The PEDro scale was used to assess risk of bias. RESULTS: There were included 12 studies. In total, 702 healthy older adults' participants were included. Pilates showed an effect in mediolateral directions in comparison to control groups (MD -1.77, 95% CI -2.84 to -0.70, p = 0.001, heterogeneity I2 = 3%), mobility (MD 9.23, 95% CI 5.74 to 12.73, p < 0.00001, heterogeneity I2 = 75%) and fear of falling (MD -8.61, 95% CI -10.16 to -7.07, p < 0.00001, heterogeneity I2 = 88%). In relation to other exercises group, Pilates showed positive effects in functional mobility (MD -1.21, 95% CI -2.30 to -0.11, p = 0.03, heterogeneity I2 = 80%), mobility (MD 3.25, 95% CI 1.46 to 5.04, p < 0.0004, heterogeneity I2 = 0%). No evidence of an improvement was found between the groups for dynamic gait index (MD 2.26, 95% CI -0.05 to 4.56, p = 0.06, heterogeneity I2 = 86%), anteroposterior directions of balance (MD -1.58, 95% CI -3.74 to -0.59, p = 0.15, heterogeneity I2 = 51%) and functional mobility when compared to control groups (no exercise) (MD -1.24, 95% CI -2.48 to -0.00, p = 0.05, heterogeneity I2 = 87%). DISCUSSION: Pilates may be effective in decreasing the risk of falls in older adults. Pilates intervention was found to improve functional mobility, mobility, gait, fear of falling and postural stability and therefore there is some evidence to suggest that Pilates reduces certain risk factors for falls in healthy older adults. However, there is an absence of high-quality evidence in regards to the impact of Pilates on reducing falls and further robust RCTs are needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO identifier CRD42021206134.

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