BACKGROUND: Pilates is one of the non-pharmacological interventions for fibromyalgia (FM). However, its impacts on pain and health-related quality of life (HRQOL) in fibromyalgia patients (FMPs) are inconclusive. This study aimed to assess the effects of Pilates on pain and HRQOL among FMPs. METHODS: A systematic review and meta-analysis were conducted. Four databases-PubMed, ScienceDirect, Scopus, and Cochrane CENTRAL-along with one grey literature source, Google Scholar, were searched for randomized controlled trials comparing Pilates with other exercises or usual care in FMPs. The outcomes were pain and HRQOL. A meta-analysis was performed using a random-effects model. RESULTS: Six studies were included (n = 265). We found that the effects of Pilates from each individual study on pain were inconsistent. Our pooled analysis of visual analog scale (VAS) scores demonstrated significant pain reduction (mean difference (MD) -0.71, 95% CI -1.33 to -0.10, p = 0.023; (I2 29.3%, p = 0.226)). However, neither the algometric score (AS) nor tender point count (TPC) showed an insignificant difference (AS: MD -0.43, 95% CI -2.60 to 1.74, p = 0.700; (I2 0.0%, p = 0.654); TPC: MD -0.16, 95% CI -2.22 to 1.89, p = 0.520; (I2 0.0%, p = 0.515)). Regarding HRQOL, Pilates showed statistically significant improvements on the Fibromyalgia Impact Questionnaire (FIQ) (MD -7.28, 95% CI -12.06 to -2.49, p = 0.003; (I2 95.7%, p < 0.001)). A sensitivity analysis of three RCTs (n = 176) based on the ACR 2010 supported this finding (MD -7.68, 95% CI -8.60 to -6.76, p < 0.001; (I2 0.0%, p = 0.832)) with non-important heterogeneity. CONCLUSIONS: Pilates may benefit FMPs. It could reduce pain and improve HRQOL. Given the small number of studies and the presence of data heterogeneity, future high-quality RCTs would provide a clearer conclusion.

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