low back pain ( lbp ) is a common disorder seen in clinical practice and is a serious 
 problem . nearly 7585% of people have experienced lbp , which has large economic and social 
 costs1,2,3 . according to the duration of the syndrome , european guidelines for physical therapy further divide lbp 
 into 3 types by its mechanism as follows : specific spinal pathology , nerve root 
 pain / radicular pain , and nonspecific lbp , with chronic nonspecific lbp as the most common 
 statistically4 . the definitions of 
 chronic lbp ( clbp ) include pain duration in the posterior lumbar region for more than 12 
 weeks4 or duration of back pain greater 
 than 712 weeks1 . the prevalence and high 
 relapse rates of nonspecific clbp often cause disability , and severely affect the quality of 
 life . in recent years , pilates has been applied in patients with clbp5,6,7,8,9,10,11,12 . created by joseph 
 pilates in the 1920s , pilates blends western yoga , greek and roman gymnastics , karate , and 
 zen , among others , and has developed into a series of physical and mental conditioning 
 exercises . it is arguable whether pilates reduces back pain and enhances the functional 
 capabilities of nonspecific clbp patients13,14,15,16,17,18 . some systematic reviews have shown that 
 when compared with a placebo or normal daily activities , pilates relieves pain but does not 
 reduce disability13 , 14 , while others have shown that pilates does not reduce disabilities 
 and/or pain15 . still others have shown 
 that when compared with a placebo or normal daily activities , pilates may effectively 
 relieve pain and reduce the degree of disability18 . however , in several other systematic reviews , pilates showed no 
 significant differences compared with any other form of exercise14 , 15 , 18 ; in another review , pilates effectively reduced 
 disabilities compared with others forms of exercise13 . the differences in the results of these studies may be due to the 
 selection size of randomized controlled trial ( rct ) articles , which included low - level 
 evidence . in addition , it was found that in some systematic reviews that regardless of the 
 existence of significant clinical heterogeneity , meta - analyses were performed and the 
 results were misleading17 . until now , conclusions from different research regarding the treatment effects on 
 pain - relief and the disability for patients with lbp from pilates and from other exercises 
 showed significant differences7 , 13,14,15,16,17,18,19 . little evidence has explored the recommendations for 
 pilates in patients with clbp ( including different forms of pilates exercise , such as mat or 
 equipment pilates)20 . therefore , the 
 purpose of the present study was to conduct a systematic review of all available studies to 
 investigate the benefit of pilates exercise for participants with clbp . in addition , we 
 compared the efficacy of pilates with other exercise practices and further explored the best 
 pilates exercise design . this study only selected articles involving rct research and that 
 achieved greater than 5 points on the pedro scale , in order to determine the best course of 
 exercise based on the highest evidence levels . a literature search was undertaken using databases including pubmed , the physiotherapy 
 evidence database ( pedro ) , medline , and cochrane library within maximal date ranges of each 
 database up until october 11 , 2015 . keywords such as  pilates  ,  chronic low back pain  , 
  chronic non - specific low back pain  ,  exercise  ,  rehabilitation  ,  pain  ,  physical 
 therapy  , and  physiotherapy  were used in data mining without language restrictions . if it was not possible to decide from 
 the abstract whether the article was suitable for inclusion , the full text was reviewed . after searching journals , then , the level of evidence 
 was further evaluated by using the pedro scale ( http://www.pedro.org.au/ ) . if not found in 
 the pedro database , the article was evaluated by 2 reviewers who had completed the pedro 
 scale training tutorial . if the evaluation results from the 2 reviewers were different , a 
 third reviewer who completed the pedro scale training tutorial was involved in the 
 evaluation for inclusion or exclusion in the study . in the case of score disagreement or 
 other problems , a group discussion was used to decide whether to include or exclude an 
 article from this study . therefore , articles with lower pedro scores ( 5 ) were excluded , to 
 reduce conclusion differences due to lower - level rcts . articles not written in english , or 
 that involved complicated diseases ( such as scoliosis or viral infections ) , were also 
 excluded . the following questions were 
 investigated : ( 1 ) pilates exercise compared with no or little intervention ( such as health 
 education ; n=5 ) ; ( 2 ) pilates exercise compared with other forms of exercise ( n=2 ) ; and ( 3 ) 
 which pilates is the best training mode . the author , publication year , subjects , intervention , 
 exercise type , and outcome measures of all included articles were extracted by 2 reviewers . when possible , data were pooled and the mean between - group differences ( 95% confidence 
 interval ) were calculated . when necessary , the original authors of the included studies were 
 contacted to provide additional information such as the mean between - group differences . if the reviewers had different 
 opinions related to article selection , data extraction , or quality assessment , a consensus 
 was achieved through discussion . forty articles were found through database searches . after we excluded duplicate articles 
 ( n=18 ) , non - rct articles , articles with a lower pedro score ( 5 ) , and articles not written 
 in english ( n=14 ) , a total of 8 rct articles were included in this systematic review . table 1table 1.pedro score for included studies ( n=8)gladwell , v. , et al.5ukrydeard , r. , et al.10canadamiyamoto , g.c . , et al.23brazilk quinn . , et al.9 uknatour , j. , et al.8 brazilwajswelner , h. , et al.11 australiamarshall , p. w. , et al.6 australiada luz , m. a. , jr . , et al.22 brazileligibility*yyyyyyyyrandom allocationyyyyyyyyconcealed allocationyyyyyyyybaseline comparabilityyyyyyyyyblind subjectsnnnnnnnnblind therapistsnnnnnnnnblind assessorsyyyyyynyadequate follow - upnyynyyyyintention - to - treat analysisnyyyyyyybetween - group comparisonsyyyyyyyypoint estimates and variabilityyyyyyyyytotal score ( 010)68878878pedro : physiotherapy evidence database ; y : yes ; n : no . * this item is not used to 
 calculate the pedro score presents the quality of included studies . the mean pedro score of included 
 articles was 7.5 with a range of 68 . all studies were randomized ( 100% ) , conducted 
 concealed allocation ( 100% ) , and had baseline comparability ( 100% ) . all studies were 
 analyzed between - group comparisons , with reported point estimates and variability ( 100% ) . blind - assessors ( 87.5% of 
 included articles ) , adequate follow - up ( 75% of included articles ) , and an intension - to - treat 
 analysis ( 87.5% of included articles ) were performed . pedro : physiotherapy evidence database ; y : yes ; n : no . * this item is not used to 
 calculate the pedro score table 2table 2.description of included studiesauthordesignparticipant ( number ) age ( years)=mean ( sd)interventionexercise mode ( frequency or intensity)outcome measuresdoes a program of pilates improve cnslbp5gladwell , v. , et al.5rct(cnslbp)>=12 weeks ; pain between lower rib cage and 
 gluteal foldspilates + drugsclinic : 1 hr , 1x per week for 6 weeks ; home : 30 
 minutes , 2x per week for 6 weeks ( total : 12 hours)rmvas , oswdq , sf-12 , sports functioning , sit - and - reach 
 test , stork stand test , symptom report , pain diaryen=25 age ( years)=36.9 ( 8.1)cn=24age ( years)=45.9 ( 8.0)normal activities + drugs6 wkspilates - based therapeutic exercise : effect on subjects 
 with nonspecific chronic low back pain and functional disability : a rct10rydeard , r. et al.10rctcnslbp>=6 weeks with or without leg painpilates ( floor mat and pilates reformer)clinic : 1 hr  3 times  4 wks ; home : 15  min(total : 
 13 hours)nrs , rmdqen=21 age ( years)=37 ( 9)cn=18 age ( years)=34 ( 8)usual care / consultation 4 wksefficacy of the addition of modified pilates exercises 
 to a minimal intervention in patients with chronic low back pain : a rct23miyamoto , g.c . , et al.23rctcnslbp>=12 weekspilates + booklet1 hr  2 times  6 wks ( total : 12 hours)nrs , rmdq , patient - specific functional scale , global 
 perceived effect scale , kinesiophobia- tampa scale , expectancy for improvement 
 scale , treatment credibility scaleen=43age ( years)=38.3 ( 11.4)cn=43age ( years)=40.7 ( 11.8)booklet 6 wks do patients with chronic low back pain benefit from 
 attending pilates classes after completing conventional physiotherapy 
 treatment?9quinn , k. et al.9rctclbp>=12 weeks with no pain radiation below 
 kneepilatesclinic : 1 hr  1 time  8wks home : 15 mins  1 time  8 
 wks ( total : 10 hours)vas , rmdq , saten=15age ( years)=41.8 ( 13.8)cn=14age ( years)=44.7 ( 12.5)8 wkspilates improves pain , function and quality of life in 
 patients with chronic low back pain : a randomized controlled trial8natour , jamil et al.8rctcnslbp>=12weeks ; pain between lower rib cage and 
 gluteal foldsnsaid + pilatespilates : 50  min . 2 times  3  m. 50  mg sodium 
 diclofenac at intervals no shorter than 8  h when needed ( vas for pain more than 
 7  cm ) . ( total : 24 hours)vas , roland morris questionnaire , sf-36 , sit and reach 
 test , nsaid intakeen=30age ( years)=47.8 ( 11.5)cn=30age ( years)=48.0 ( 13.0)nsaid50  mg sodium diclofenac at intervals no shorter than 8  h when 
 needed ( vas for pain more than 7  cm).clinical pilates versus general exercise for chronic 
 low back pain11wajswelner henry et al.11rctclbp>=12 weeks with or without lower limb 
 syndromepilates ( with equipment ) + daily home programclinic : 1 hr  2 times  6 wks ; home : 1 hr  1 time 
 ( total : 1214 hours)quebec scale , nrs , pain self- efficacy questionnaire , 
 patient- specific functional scale , sf-36en=44age ( years)=49.3 ( 14.1)cn=43age ( years)=48.9 ( 16.4)general exercise + daily home programpilates exercise or stationary cycling for chronic 
 nonspecific low back pain : does it matter?6marshall , p. w. et al.6rctcnslbp>=12 weeks pain located costal margins and 
 inferior gluteal foldspilates ( mat + equipment)1 hr  3 times  8 wks ( total : 24 hours)vas , oswdq , fear - avoidance beliefs questionnaire , pain 
 catastrophizing scaleen=32age ( years)=36.2 ( 8.2)cn=32age ( years)=36.2 ( 6.2)stationary cycling effectiveness of mat pilates or equipment - based pilates 
 exercises in patients with chronic nonspecific low back pain : a randomized 
 controlled trial22m.a . da luz jr et al.22rctcnslbp>=12 weeksequipment - based pilates1 hr  2 times  6 wks ( total : 12 hours)nrs , rmdq , global perceived effect scale , tampa 
 scaleen=43age ( years)=43.5 ( 8.6)cn=43age ( years)=38.8 ( 9.9)mat pilatesvalues are n : number ; e : experimental group ; 
 c : control group ; clbp : chronic low back pain ; cnslbp : chronic non - specific low back 
 pain ; vas : visual analogue scale ; rct : randomized control trial ; rmvas : roland morris 
 pain rating visual analogue scale ; oswdq : oswestry low - back pain disability 
 questionnaire ; nrs : numerical rating scale ; rmdq : roland morris disability 
 questionnaire ; sat : sahrmann abdominal test ; sf : social functioning ; nsaid : 
 non - steroidal anti - inflammatory drug provides the summarized information ( including author , experimental design , 
 participants , intervention , comparison , and outcome measures ) for each rct article . the ages 
 of the experimental subjects ranged from 3449  years of age5,6,7,8,9,10,11 , 22 . only 1 rct article 
 discussed and compared pilates and usual care / health education by age distribution5 . for all other articles , supervised pilates intervention was 
 included in most of the rct articles , and the rct pilates programs lasted for 1 hour each 
 time , 13 times per week for 612 weeks . a total of 6 weeks of exercise intervention were 
 reported in 4 rct articles5 , 7 , 11 , 22 , and 8 weeks in 2 rct articles6 , 9 . the other 2 rct 
 articles used a 4-week intervention10 and 
 a 12-week intervention8 , respectively . additionally , in 4 of 8 articles , pilates equipment such as a reformer was reportedly 
 used6 , 10 , 
 11 , 22 . n : number ; e : experimental group ; 
 c : control group ; clbp : chronic low back pain ; cnslbp : chronic non - specific low back 
 pain ; vas : visual analogue scale ; rct : randomized control trial ; rmvas : roland morris 
 pain rating visual analogue scale ; oswdq : oswestry low - back pain disability 
 questionnaire ; nrs : numerical rating scale ; rmdq : roland morris disability 
 questionnaire ; sat : sahrmann abdominal test ; sf : social functioning ; nsaid : 
 non - steroidal anti - inflammatory drug for the following reasons , outcomes were not pooled into the meta - analysis . there was 
 apparent clinical heterogeneity in the included rct studies as shown by the conditions that 
 were treated , frequency and duration of intervention with pilates and other exercises , such 
 as home exercise and education , administration of nonsteroidal anti - inflammatory drugs , use 
 of pilates equipment , the performance of follow - up , and evaluations of outcome measures over 
 different periods ( table 2)18 . in addition , the test for heterogeneity showed that 
 significant statistical heterogeneity for pain relief : pilates exercise against minimal 
 intervention and therapeutic training ( i=73% , p=0.001 ) . significant statistical heterogeneity was also observed when comparing improvements in 
 functional ability with pilates exercise versus minimal intervention and therapeutic 
 training ( i=92% , p<0.001 ) . among the included articles , 5 compared the effect of pilates and minimal intervention 
 ( such as routine care and health education ) on patients with clbp ( table 3table 3.effect of pilates exercise versus minimal intervention or usual carestudyoutcome measuremean difference between groups / exp . minus ctrlsignificance of difference between groupsattain mcid gladwell , v. , et al.5rmvasna -- oswdqna -- sports functioningna -- sf-12 : general healthna -- one - leg standing balance ( s)na -- flexibilitynabetween groups p<0.05nadaily diarynabetween groups p<0.05narydeard , r. , et al.10rmdq1.2between groups p<0.023-pnrs5.6p=0.002+miyamoto , g.c . , et al.23pnrs6 wk2.26-week between groups p<0.01+rmdq6 wk2.7between groups p<0.01+patient - specific functional scale6 wk0.4 - -global perceived effect scale6 wk1.56-week follow - up between groups p<0.01nakinesiophobia- tampa scale 6 wk1.6 - -k quinn . , et al.9rmdq1.26 - -sat27%--vas : follow up14.2 ( mm)between groups p=0.047-natour , j. , et al.8vast450.46between group p<0.001-t901.12t1801.63roland - morris questionnaire ( rm)t452.08between group p<0.001+t903.80t1803.62sf-36physical functioningt455.12between group p=0.026nat908.54t1805.83vitalityt456.33between group p=0.029nat9010.58t1805.29bodily paint454.25between group p=0.030nat908.04t1808.29sit - and - reach testt455.63 - -t906.77t1806.54satisfaction with treatment ( likert scale)t45 - --t90t180nsaid uset455.90between groups p<0.010nat905.66t1807.13mcid : minimal clinical importance difference ; na : not available ; rmvas : roland morris 
 pain rating visual analogue scale ; oswdq : oswestry low - back pain disability 
 questionnaire ; pnrs : pain numerical rating scale ; rmdq : roland morris disability 
 questionnaire ; sat : sahrmann abdominal test ; sf : social functioning ; nsaid : 
 non - steroidal anti - inflammatory drug ; t45 : 45 days after baseline ; t90 : 90 days after 
 baseline ; t180 : 180 days after baseline ) . after 412 weeks of pilates or minimal intervention , all studies showed 
 significant statistical differences for effects on pain relief5 , 8,9,10 , 23 . however , only 2 of these 5 showed that the pain relief reached 
 minimal clinically important differences ( mcid)10 , 
 23 . compared with no treatment , the visual analogue scale ( vas ) 
 score for pain relief showing an mcid in patients with clbp was reportedly 18  mm24 ; the mcid on the numeric rating scale 
 ( nrs ) was 2 points18 . the mcid on the 
 roland morris disability questionnaire ( rmdq ) for functional capacity in patients with clbp 
 was 2 points8 , 25 . in 3 of the 5 articles , patients indicated an improvement in 
 functional ability with significant statistical differences after 412 weeks of pilates or 
 minimal intervention8 , 10 , 23 , but two of them 
 achieved mcid8 , 23 . after 4 and 12 weeks of pilates , some functional abilities were 
 maintained for up to 1210 and 24 
 weeks8 , respectively8 , 10 . mcid : minimal clinical importance difference ; na : not available ; rmvas : roland morris 
 pain rating visual analogue scale ; oswdq : oswestry low - back pain disability 
 questionnaire ; pnrs : pain numerical rating scale ; rmdq : roland morris disability 
 questionnaire ; sat : sahrmann abdominal test ; sf : social functioning ; nsaid : 
 non - steroidal anti - inflammatory drug ; t45 : 45 days after baseline ; t90 : 90 days after 
 baseline ; t180 : 180 days after baseline among included articles , 2 rct studies compared the effects of pilates and other exercise 
 types on patients with clbp ( table 4table 4.effect of pilates exercise versus therapeutic exercise trainingstudyoutcome measuremean difference between groups / exp . minus ctrl.significance of difference between groupsattain mcidwajswelner , h. , et al.11quebec scalew63.5 --w120.91-w242.0 -pnrsw60.5 --w120.3 -w240.3 -psfsw61.0 --w120.8 -w241.0 -sf-36 physical functionw61.7 --w125.9 --w242.9 --role physicalw60.2 --w120.8 --w244.3 --bodily painw60.8 --w124.7 --w243.4 -general healthw62.2 --w121.0 --w241.5 --vitalityw60.2 --w121.4 --w241.6 --social functioningw63.4 --w122.5 --w244.2 - -role emotionw63.0 --w123.9 --w245.7 --mental healthw65.7 --w121.8 --w244.5 --pain self - efficacy questionnairew62.1 - -w121.9 --w241.3 --marshall , p. w. , et al.6vasw81.1 between groups p<0.05-w240.4 - -odiw86.8between groups p<0.05-w244.4 - -fear - avoidance beliefs questionnaire ( physical 
 activity)w82.2 - -w242.0 - -pain catastrophizing scalew82.3 - -w240.04 - -mcid : minimal clinical importance difference ; pnrs : pain numerical rating scale ; 
 psfs : patient - specific functional scale ; vas : visual analogue scale ; w6 : 6 weeks after 
 baseline ; w12 : 12 weeks after baseline ; w24 : 24 weeks after baseline ; w8 : 8 weeks 
 after baseline ) . in 1 of these , pilates achieved significant statistical differences in the 
 improvement in pain relief and functional ability after an 8-week training period , when 
 compared with other exercise ( stationary cycling ) , but mcid was not achieved in either 
 study6 ; in the other study , the outcome 
 measures of 6 weeks of pilates and general exercise ( including stationary bike , leg 
 stretches , upper body weights , theraband , swiss ball , and floor exercise ) were similar11 . mcid : minimal clinical importance difference ; pnrs : pain numerical rating scale ; 
 psfs : patient - specific functional scale ; vas : visual analogue scale ; w6 : 6 weeks after 
 baseline ; w12 : 12 weeks after baseline ; w24 : 24 weeks after baseline ; w8 : 8 weeks 
 after baseline among the included high - quality articles , only 1 compared the effects of mat - pilates and 
 equipment - based exercise on patients with nonspecific clbp ( table 5table 5.effect of mat pilates exercise versus equipment - based pilates exercisestudyoutcome measuremean difference between groups / exp . minus ctrlsignificance of difference between groupsattain mcidda luz , m. a. , jr . , et al.22pnrsw60.3 ( 1.1 to 1.7)--w240.1 ( 1.5 to 1.3)--rmdqw61.0 ( 3.4 to 1.4)--w243.0 ( 0.6 to 5.4)++patient - specific functional scale w60.1 ( 1.1 to 0.9)--w241.1 ( 2.1 to 0.1)+naglobal perceived effect scalew60.1 ( 1.1 to 1.4)--w241.2 ( 2.4 to 0.1)--tampa scale for kinesiophobiaw60.8 ( 2.5 to 4.1)--w244.9 ( 1.6 to 8.2)+namcid : minimal clinical importance difference ; pnrs : pain numerical rating scale ; rmdq : roland morris disability questionnaire ; na : not available ; w6 : 6 weeks after 
 baseline ; w24 : 24 weeks after baseline ) . after 6 weeks of mat - pilates training or 6 weeks using pilates equipment , 
 such as the cadillac , reformer , ladder barrel , or step - chair , patients indicated similar 
 improvements . however , after 24 weeks , there was greater improvement in the outcomes of 
 functional ability and kinesiophobia in patients in equipment - based pilates groups than in 
 patients in the mat - pilates group22 . mcid : minimal clinical importance difference ; pnrs : pain numerical rating scale ; 
 rmdq : roland morris disability questionnaire ; na : not available ; w6 : 6 weeks after 
 baseline ; w24 : 24 weeks after baseline this systematic review based on high - quality rct studies provides updated evidence for the 
 effects of pilates on patients with nonspecific clbp . meta - analysis was not performed 
 because of the clinical and statistical heterogeneity among the rct articles18 . according to studies included in the 5 high - quality rct articles that compared the effects 
 of pilates and minimal intervention in nonspecific clbp patients , 612 weeks of pilates 
 training is better than minimal intervention in reducing pain in the short term5 , 8,9,10 , 23 , and this improvement can be clinically 
 significant10 , 23 . reported that 12 weeks of pilates ( 24 total hours of 
 training ) could reduce clbp pain for 24 weeks . some of our included high - quality articles 
 ( 40% ) also indicated clinical differences in functional capacity8 , 10 , 23 . equipment training was included in pilates exercise in 2 high - quality rct articles that 
 compared the effects of pilates and other types of exercise on patients with clbp6 , 11 . wajswelner et al . reported that 1214 hours of pilates showed no statistical superiority 
 over therapeutic exercise in patients with clbp11 . , indicating 
 that for clbp patients , pilates and lumbar stabilization exercises showed similar effects on 
 pain relief and functional enhancement15 . 
 for a longer pilates routine ( up to 24 hours ) , marshall et al . found that although pilates 
 showed statistically superior results for pain relief and functional enhancement in patients 
 with lbp compared with stationary cycling , however , no mcid was observed6 . it is possible that pilates and therapeutic 
 exercise showed similar results in the report by wajswelner et al . because both focused on 
 the trunk ( especially extension , rotation , and flexion ) . indicated that the 
 psychological influences on patients with lbp in the pilates and stationary cycling groups 
 were the same . therefore , psychological factors should not be considered a cause for 
 statistical differences in lbp pain relief or functional enhancement . some researchers have 
 reported that the relative ratio ( nearly 10% ) of cycling for trunk muscle recruitment is 
 lower than the relative ratio ( > 50% ) for specific trunk exercises for trunk muscle 
 recruitment6 , 26 , 27 . hayden et al . indicated 
 that regardless of the type of therapeutic exercise , a minimum of 20 cumulative hours of 
 continuous training shows clinical analgesic effects and functional enhancement for 
 nonspecific clbp28 . therefore , in 
 patients with lbp , training duration ( dose or intensity ) in addition to waist or torso 
 training may also be a factor in the effectiveness of exercise . proposed that to alleviate pain and enhance functional capabilities , patients 
 with lbp need to be encouraged to adhere to a minimum training period of 20 hours28 . we recommend that patients with clbp 
 doing pilates training should have an exercise frequency greater than 2 or 3 times a week , 
 with each session lasting at least 1 hour , for a minimum cumulative training of 20 hours . one high - quality article showed that after 6 weeks of mat - pilates training or 6 weeks using 
 pilates equipment ( e.g. , cadilliac , reformer , ladder barrel , or step - chair ) , patients with 
 clbp had similar improvements . however , disability improvement and kinesiophobia in these 
 patients showed better and longer - lasting results ( up to 24 weeks ) with equipment - based 
 pilates than with mat - pilates . the reason is that ultrasonic examination 
 confirmed that performance of some pilates exercises ( such as the hundred ) using pilates 
 equipment showed thicker transverse abdominal muscles than with mat - pilates29 . the transverse abdominal muscles are deep , cross - joint and local 
 core muscles . the activation of deeper muscles may exert a stiffening effect on the lumbar 
 region to help stabilize the spinal segment29 , 30 . this may lead to improvement in 
 functional activities in nonspecific clbp patients , in part through an increase in 
 self - confidence . on rct research ( not included because of its low pedro scale ) 
 showed different results . for businesswomen doing 8 weeks of pilates exercise , the article 
 showed that subjects had better balance with mat - pilates exercise than with pilates 
 apparatus exercise , and were better able to reduce clbp . although these 2 results seem to 
 contradict each other , they did not investigate nonspecific clbp rmdq , and the vas mean 
 differences did not achieve mcid31 . also did not report whether there was supervision for pilates therapy . without 
 monitoring by an experienced therapist , incorrect pilates movements could result in a lack 
 of strenuous training of core muscles such as the transverse abdominal or abdominal 
 oblique29 . similar to the report by wells et al.18 , 
 which compared health education and pilates , this study found that pilates provided greater 
 improvement for pain relief and functional ability . however , when compared with other forms 
 of therapeutic exercise , pilates showed similar results without mcids . future research may include testing 
 parameters suggested in the hayden article , or may determine the effectiveness of reports by 
 australian physical therapists that the use of pilates exercise can achieve optimal results 
 if performed for 36 months20 , 28 . since this review only included high - quality rct studies , there were few articles that 
 compared the effects of pilates intervention and other exercises on patients with clbp , and 
 few articles that compared the effect of mat - pilates versus equipment - based pilates . in some 
 articles , the insufficiency of raw numeric data made the calculation of the mean difference 
 between the experimental and control groups impossible . in addition , we did not restrict 
 language in the data - mining process , but only included english language articles . lastly , we did not include unpublished studies , so there is likely 
 some publication bias .
[ purpose ] to evaluate the effects of pilates on patients with chronic low back pain 
 through a systematic review of high - quality articles on randomized controlled trials . 
 [ subjects and methods ] keywords and synonyms for  pilates  and  chronic low back pain  
 were used in database searches . 
 the databases included pubmed , physiotherapy evidence 
 database ( pedro ) , medline , and the cochrane library . 
 articles involving randomized 
 controlled trials with higher than 5 points on the pedro scale were reviewed for 
 suitability and inclusion . 
 the methodological quality of the included randomized 
 controlled trials was evaluated using the pedro scale . 
 relevant information was extracted 
 by 3 reviewers . 
 [ results ] eight randomized controlled trial articles were included . 
 patients with chronic low back pain showed statistically significant improvement in pain 
 relief and functional ability compared to patients who only performed usual or routine 
 health care . 
 however , other forms of exercise were similar to pilates in the improvement 
 of pain relief and functional capacity . 
 [ conclusion ] in patients with chronic low back 
 pain , pilates showed significant improvement in pain relief and functional enhancement . 
 other exercises showed effects similar to those of pilates , if waist or torso movement was 
 included and the exercises were performed for 20 cumulative hours .