Čedomir Bajčetić, Vojin Rudović, Milica Novaković, Mirela Vještica, Roksanda Atanasov, Vuk Ralić, Marko Manojlović, Patrik Drid
Although Pilates has become an increasingly popular form of exercise among adult women, previous systematic reviews have often combined heterogeneous populations and outcomes, leaving the specific effects of structured Pilates programs on health-related physical fitness in this population insufficiently clarified. This systematic review and meta-analysis examined the effects of structured Pilates programs on health-related physical fitness components in adult women, following PRISMA 2020 guidelines with a prospectively registered PROSPERO protocol. A literature search was conducted in PubMed, Web of Science, and Google Scholar up to 21 January 2026. Of 751 records identified, 12 studies (2007-2025, approximately 540 female participants) were included in the final synthesis, and meta-analyses were performed using Review Manager 5.4.1 with a random-effects model. Pilates interventions produced statistically significant improvements in body mass index (MD = -1.22; 95% CI: -1.83 to -0.61; p < 0.001), body weight (MD = -3.99 kg; 95% CI: -6.30 to -1.67; p = 0.0007), and sit-and-reach flexibility (SMD = 0.69; 95% CI: 0.43 to 0.94; p < 0.001), whereas no significant pooled effects emerged for body fat percentage, waist circumference, waist-to-hip ratio, lean body mass, handgrip strength, or vertical jump. Narrative synthesis suggested additional positive effects on muscular strength, endurance, balance, functional abilities, and respiratory parameters. Pilates appears to be a safe, effective method for improving selected body composition parameters and flexibility in adult women, though findings warrant cautious interpretation given heterogeneity in study design, intervention protocols, and methodological quality. This study was supported by the Provincial Secretariat for Higher Education and Scientific Research (grant 142-451-3098).