1. Introduction
Work-related musculoskeletal disorders (WRMSDs) represent one of the most prevalent and costly occupational health challenges globally, affecting employees across sedentary, manual, and mixed-demand professions. Epidemiological data indicate that WRMSDs account for approximately 30% to 50% of all occupational diseases worldwide, severely impacting global health metrics and imposing an immense economic burden through direct medical costs and lost productivity [ 1 , 2 , 3 ]. Prolonged sitting, repetitive loading, suboptimal workstation ergonomics, and elevated psychosocial strain contribute to chronic pain, reduced functional capacity, and diminished quality of life [ 1 , 2 , 3 ]. Office-based workers frequently present with chronic low back pain (CLBP) and neck pain, often accompanied by postural syndromes such as Upper Cross Syndrome (UCS), characterized by forward head posture and thoracic hyperkyphosis [ 4 , 5 ]. Conversely, workers in manual labor sectors, including agriculture and manufacturing, experience distinct biomechanical demands that require mechanistically informed interventions tailored to their occupational exposures [ 6 , 7 ]. These diverse risk profiles underscore the need for accessible, evidence-based strategies capable of addressing both the physical and psychosocial determinants of worker health.
Pilates has emerged as a promising biopsychosocial intervention within this context. As a mind–body exercise system integrating core stabilization, controlled breathing, and neuromuscular re-education, Pilates has been reported in foundational literature to provide meaningful functional improvements across diverse populations [ 1 , 2 , 3 , 5 , 8 ]. The method is fundamentally grounded in six foundational principles: centering, concentration, control, precision, breath, and flow, which collectively function to optimize movement quality and enhance neuromuscular efficiency [ 9 , 10 ]. Biomechanically, the precise integration of these principles targets deep muscular stabilization, specifically increasing the recruitment and thickness of vital trunk stabilizers such as the transversus abdominis, thereby directly counteracting the mechanical deficits induced by prolonged, static occupational postures [ 10 ]. Concurrently, from a psychophysiological perspective, the demand for continuous internal focus, mindful somatic awareness, and regulated diaphragmatic breathing establishes a robust cognitive–somatic link; this mechanism serves to downregulate autonomic arousal, thereby mitigating work-related stress, subclinical anxiety, and burnout while actively promoting employee subjective well-being [ 11 ].
Mechanistic evidence suggests that Pilates influences both biomechanical and cognitive–affective pathways, including reductions in pain catastrophizing and kinesiophobia [ 12 ]. In occupational settings, preliminary evidence derived from randomized controlled trials (RCTs) and pilot studies suggests that interventions of 8–12 weeks are associated with improvements in postural alignment, muscle endurance, and functional capacity [ 13 , 14 , 15 , 16 , 17 ]. Workplace-adapted Pilates protocols may also help address postural deviations characteristic of UCS by strengthening deep cervical flexors and scapular stabilizers [ 18 , 19 ].
The psychosocial dimension of worker health is equally critical. Pilates has been associated with reductions in subclinical symptoms of anxiety, depression, and stress, alongside improvements in vitality, emotional well-being, and sleep quality [ 11 , 20 , 21 , 22 , 23 , 24 , 25 ]. Crucially, within the context of occupational wellness, these investigated parameters typically reflect variations in subclinical psychological distress and subjective well-being rather than diagnosed psychiatric disorders classified under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). During the COVID-19 pandemic, healthcare workers experienced unprecedented psychological strain; preliminary evidence suggests that clinical Pilates, including telerehabilitation formats, may reduce pain and improve mental health in these high-stress professions [ 23 , 26 ]. By enhancing autonomic regulation and promoting muscular relaxation, Pilates may also support restorative sleep and cognitive resilience, both of which are essential for work recovery.
Beyond clinical and psychosocial outcomes, the integration of Pilates into occupational health frameworks carries important economic implications. Musculoskeletal pain is a major driver of productivity losses through absenteeism and, more prominently, presenteeism—working while symptomatic [ 27 , 28 ]. By improving musculoskeletal endurance and psychological resilience, Pilates may mitigate these burdens. Recent budget impact analyses indicate that implementing group-based Pilates can generate substantial societal savings, approximately Int$ 172 million over five years in large-scale systems, primarily through reductions in disability-related costs and productivity losses [ 27 ]. These findings position Pilates not only as a therapeutic modality but also as a potentially cost-effective component of occupational health and safety strategies.
Despite the growing body of evidence, no systematic review has comprehensively synthesized the effects of Pilates across the three interconnected domains of occupational health: (1) physical and musculoskeletal function, (2) psychosocial well-being, and (3) ergonomics and economic risk reduction. Existing reviews have typically focused on isolated outcomes or specific clinical populations, limiting their applicability to workplace settings. Therefore, describing the rationale for this review in the context of existing literature highlights the need for a holistic synthesis that bridges these fragmented areas.
The present systematic review aims to synthesize the existing evidence from diverse worker populations and to map the potential of the Pilates method as a comprehensive, biopsychosocial intervention for the modern workplace.
2. Materials and Methods
This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) updated guidelines. The review protocol was established prior to the execution of the search strategy and was prospectively registered in the PROSPERO International Prospective Register of Systematic Reviews (Registration number: CRD420261390771).
2.1. Search Strategy
A comprehensive and systematic literature search was conducted to identify relevant studies investigating the impact of Pilates in the workplace. The search was performed across three major electronic databases (PubMed, Scopus, and PEDro) and supplemented by two comprehensive meta-search engines (Web of Science and Google Scholar). The search retrieved a total of 863 records (PubMed: n = 144; Scopus: n = 211; Web of Science: n = 123; PEDro: n = 57; Google Scholar: n = 328).
The final search for all databases was conducted on 30 April 2026. No language or publication date restrictions were applied to ensure comprehensive retrieval of evidence. The search strategy utilized a combination of Medical Subject Headings (MeSH) and free text terms. To ensure full reproducibility, the detailed, database-specific search strings tailored to the syntax requirements of each platform are provided in Appendix A .
2.2. Eligibility Criteria
To determine the eligibility of the studies, specific inclusion and exclusion criteria were defined based on the PICOS (Population, Intervention, Comparator, Outcomes, Study design) framework, combined with a specific Context (C).
Population: The review included working adults (aged 18–65 years) across various occupational sectors (e.g., corporate office workers, healthcare professionals, industrial/loom workers, and agricultural farmers). Eligible participants included healthy employees participating in workplace health promotion programs, as well as those suffering from or at risk of work-related musculoskeletal disorders (e.g., chronic low back pain, postural misalignments) and psychosocial challenges (e.g., job stress, anxiety, burnout). Studies involving participants under the age of 18, retirees, professional athletes, pregnant women (unless the focus was explicitly on workplace ergonomics), and individuals with severe medical pathologies unrelated to occupational contexts (e.g., acute fractures, malignancies) were excluded.
Intervention and Context: Eligible interventions included any program based on the Pilates method (e.g., Mat work, Reformer, or chair-based modified Pilates) designed for and evaluated within an occupational context. These encompassed interventions delivered on-the-job, online, or via supervised home/studio settings specifically targeting employees. Programs of any duration were accepted. Pilates could be combined with secondary interventions (e.g., ergonomic education, massage) provided that Pilates was the core component. General physical activity programs, yoga, or weightlifting lacking distinct Pilates principles, as well as multimodal programs where Pilates was a minor component, were excluded.
Comparator: Studies utilizing passive control groups (e.g., usual care, wait-list) or active control groups (e.g., alternative physical therapies, McKenzie method, neck stabilization, ergonomic education) were included. For quasi-experimental designs, the participants’ own baseline (pre-intervention) measurements served as the comparator. Studies comparing two different versions of Pilates without a distinct alternative control group or baseline, as well as those using pharmacological or surgical comparators, were excluded.
Study Design: A broad range of quantitative designs was included to capture all relevant evidence. This comprised Randomized Controlled Trials (RCTs), pilot RCTs, non-randomized controlled trials, quasi-experimental studies (e.g., one-group pretest–posttest designs), and structured observational studies. Qualitative studies lacking quantitative data, cross-sectional studies without an intervention phase, case reports (n < 5), narrative/systematic reviews, and conference abstracts lacking detailed methodologies were excluded.
2.3. Study Selection and Data Extraction
Following the initial search, all identified records were exported to reference management software where duplicates were removed. Prior to formal screening, the two reviewers piloted the eligibility criteria on a random sample of 50 abstracts to ensure consistent interpretation and refine operational definitions. This calibration step aimed to minimize discrepancies during the main screening phase. Two independent reviewers then screened the titles and abstracts of the remaining records against the eligibility criteria. Studies that appeared relevant underwent a full-text review. All disagreements between the two reviewers at any stage (title/abstract screening, full-text assessment, data extraction, and risk-of-bias evaluation) were resolved through discussion. When consensus could not be reached, a third independent reviewer adjudicated the decision.
Data from the final included studies were systematically extracted using a standardized template. Extracted information included study characteristics (author, year, country, design), participant demographics (sample size, occupation), intervention details (Pilates type, protocol duration, frequency, setting), specific outcome measurement tools, and key findings categorized by evidence pillar (Physical/Musculoskeletal, Mental/Psychological, and Ergonomic/Occupational).
2.4. Quality Assessment and Risk of Bias
The methodological quality and risk of bias of the included studies were assessed independently by two reviewers. Due to the methodological heterogeneity of the included studies, two distinct tools were utilized. The Cochrane Risk of Bias 2 (RoB 2) tool was applied to all Randomized Controlled Trials (RCTs), evaluating five domains: the randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. The Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool was employed for quasi-experimental and observational studies, assessing seven domains: confounding, selection of participants, classification of interventions, deviations from intended interventions, missing data, measurement of outcomes, and selection of the reported result.
Inter-rater agreement for risk-of-bias assessments was high. Although a formal κ statistic was not calculated, concordance between reviewers was consistently strong across domains. Based on these tools, studies were classified as having an overall “Low”, “Moderate/Some Concerns”, “High/Serious”, or “Critical” risk of bias.
2.5. Data Synthesis
A qualitative narrative synthesis was conducted to summarize the findings of the included studies. Although 12 Randomized Controlled Trials (RCTs) were identified, a quantitative meta-analysis was deemed inappropriate due to substantial clinical and methodological heterogeneity. Specifically, the included interventions varied markedly in Pilates delivery (Matwork, Reformer, and chair-based protocols), session frequency (one to five sessions per week), and total duration (4 weeks to 9 months). Additionally, the occupational sectors represented (office-based, healthcare, and manual labor) introduced diverse ergonomic exposures and baseline physical demands. Methodological heterogeneity was also evident in the comparator groups, which ranged from non-active controls and posture education to conventional physical therapy, as well as in the diversity of outcome measures. The use of multiple disparate scales for pain (e.g., VAS, NRS) and disability (e.g., ODI, NDI, RMDQ), coupled with inconsistent reporting of standard deviations or effect sizes in several studies, prevented harmonization into a common effect metric. While the Standardized Mean Difference (SMD) could theoretically address the use of disparate measurement scales, its application was deemed inappropriate given that the extensive clinical heterogeneity, spanning vastly different occupational demands and intervention protocols, would render any pooled effect size statistically unreliable and clinically misleading. Even within pain outcomes, the heterogeneity of measurement tools and reporting formats precluded subgroup meta-analysis. Pooling such heterogeneous data would have produced misleading summary estimates and violated core assumptions of meta-analytic modelling.
Given the mixture of RCTs and quasi-experimental studies, the Synthesis Without Meta-analysis (SWiM) framework provided the most appropriate structure for organizing and transparently reporting the evidence. To ensure a rigorous synthesis, predefined grouping rules were implemented, categorizing data into three primary conceptual domains based on our biopsychosocial framework: (1) physical health and musculoskeletal function (subdivided into pain intensity, muscle endurance, and flexibility), (2) mental and psychological well-being (job-related stress, subclinical anxiety/depression, burnout, and sleep parameters), and (3) occupational performance and ergonomics (presenteeism, absenteeism, and job satisfaction). Within each domain, the direction-of-effect was structured and determined based on the statistical significance ( p < 0.05) and clinical relevance of the reported post-intervention changes, classifying findings as ‘favorable effect’, ‘no clear effect’, or ‘unfavorable effect’ relative to the respective comparator groups. Furthermore, to specify the outcome metrics used without statistical pooling, individual study effect measures, predominantly absolute mean differences, percentage changes, or native scale scores, were systematically tabulated within comprehensive evidence tables where available, ensuring direct alignment with SWiM reporting guidelines. Due to the qualitative nature of the synthesis and the high heterogeneity, a formal assessment of publication bias via funnel plots was not feasible; however, potential selective reporting was critically appraised within the Risk of Bias framework. In light of these methodological constraints, the synthesis prioritized transparent reporting and structured grouping of outcomes rather than statistical pooling, ensuring full alignment with SWiM recommendations.
3. Results
This section presents the comprehensive findings of the systematic review, beginning with a detailed chronological overview of the literature search and study selection process. It further outlines the baseline characteristics of the included literature and provides a structured, qualitative synthesis of the empirical evidence organized around our three primary conceptual pillars: physical and musculoskeletal health, mental and psychological well-being, and ergonomic and occupational performance.
3.1. Study Selection
The systematic search across electronic databases initially identified 863 records. After the removal of 250 duplicates, 613 records were screened based on title and abstract. Of these, 534 were excluded as they did not meet the basic inclusion criteria. The remaining 79 reports were sought for full-text assessment and formally evaluated for eligibility. Following a rigorous eligibility check against the PICO framework, 55 reports were excluded for the following specific reasons: 18 reports involved an incorrect or non-eligible population, 21 lacked a specific or core Pilates-based intervention, 9 utilized an incorrect or non-quantitative study design, and 7 reported irrelevant or missing quantitative outcomes. Ultimately, 23 original studies (represented in 24 publications) were included in the qualitative synthesis. The complete screening process is detailed in the PRISMA 2020 Flow Diagram ( Figure 1 ).
3.2. Characteristics of Included Studies
The summary characteristics of the 23 included studies are presented in Table 1 . The studies were conducted in diverse geographical regions, reflecting the global interest in workplace Pilates, including Brazil, USA, Italy, Czech, Iran, Germany, Ukraine, Egypt, South Korea, and others. The publication dates range from 2014 to 2026.
Regarding the study populations, the synthesis included a total of 1179 participants (noting that three studies did not specify an exact sample size). The participants spanned various professional sectors, with a high concentration of office workers, healthcare professionals (nurses and hospital staff), and industrial workers. The study designs were predominantly Randomized Controlled Trials (RCTs) and quasi-experimental studies.
3.3. Synthesis of Evidence by Pillar
To provide a structured overview of the benefits of Pilates in the occupational context, the findings were categorized into three primary evidence pillars: (1) Physical and Musculoskeletal, (2) Mental and Psychological, and (3) Ergonomic and Occupational outcomes. A summary of the evidence per pillar for each included study is provided in Table 2 .
The analysis indicates that Pilates interventions consistently led to significant reductions in pain (particularly chronic low back and neck pain) and improvements in physical function. Psychologically, the studies reported decreased levels of anxiety, depression, and job stress. Furthermore, ergonomic benefits included improved postural alignment and enhanced job satisfaction.
3.4. Pilates Intervention Protocols
The specific characteristics of the Pilates protocols, including the method used, duration, frequency, and setting, are detailed in Table 3 . The most frequent intervention type was Matwork Pilates, often supplemented with accessories like small balls or magic circles, while Reformer-based programs were also utilized.
Protocol durations typically ranged from 4 to 12 weeks, with a frequency of 2 to 3 sessions per week. A significant portion of the interventions was delivered in a supervised format, either in-person at the workplace or in specialized studios, emphasizing the importance of professional guidance in ensuring exercise quality and safety.
3.5. Outcome Mapping and Measurement Tools
The variety of assessment tools employed across the studies to capture the multidimensional impact of Pilates is mapped in Table 4 . Pain was most commonly assessed using the Visual Analogue Scale (VAS) or the Numerical Pain Rating Scale (NPRS), while functional disability was frequently measured via the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI). Psychosocial outcomes were captured through validated scales such as the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS).
3.6. Methodological Quality and Risk of Bias
Finally, the methodological quality of the evidence was evaluated to determine the reliability of the findings. The risk of bias assessment for both randomized and non-randomized studies is presented in Table 5 .
While several RCTs demonstrated a low risk of bias, particularly in outcome measurement and reporting, “some concerns” were noted in others regarding the randomization process or the blinding of participants (which is inherently difficult in exercise-based interventions). Non-randomized studies generally exhibited a higher risk of bias, often due to the lack of a control group or potential confounding factors.
3.7. Summary of Evidence (GRADE)
A GRADE assessment was conducted to evaluate the certainty of evidence across the core outcomes included in this review. Table 6 summarizes the overall strength of evidence derived exclusively from randomized controlled trials. Across eight RCTs, Pilates interventions consistently demonstrated short-term reductions in pain, yielding moderate-certainty evidence, downgraded for risk of bias and imprecision due to small sample sizes. Similarly, six RCTs reported improvements in functional disability, also resulting in moderate-certainty evidence. Evidence for psychological outcomes (anxiety, depression, stress, kinesiophobia, catastrophizing, sleep) was supported by only two RCTs using heterogeneous measurement tools, including one study with high risk of bias, leading to low-certainty evidence. Finally, QALYs and cost-effectiveness were examined in a single high-quality RCT, providing moderate-certainty evidence, downgraded for imprecision due to single-study data. Overall, the GRADE evaluation indicates that Pilates probably improves pain, disability, and QALYs in working populations, while psychological benefits remain less certain. The detailed rationale for downgrading decisions is presented in the Section GRADE Footnotes.
GRADE Footnotes
Risk of Bias Several RCTs showed “some concerns” in randomization, deviations from intended interventions, or outcome measurement. One psychological-outcome RCT had high risk of bias. This domain was downgraded by one level for pain, disability, and psychological outcomes.
Inconsistency Effects were generally consistent for pain and disability. Psychological outcomes showed variability due to different measurement tools and populations. This domain was downgraded by one level for psychological outcomes.
Indirectness No serious indirectness was identified, as all studies involved working adults and assessed relevant occupational or clinical outcomes. No downgrade was applied.
Imprecision Most RCTs had small sample sizes (<50 participants). Psychological outcomes were supported by only two RCTs, and QALYs were supported by a single RCT. This domain was downgraded by one level for pain, disability, psychological outcomes, and QALYs.
Publication Bias A formal assessment (e.g., funnel plot) was not feasible due to the absence of a meta-analysis. No downgrade was applied, although potential bias cannot be excluded.
4. Discussion
To our knowledge, this is the first systematic review to synthesize the effects of Pilates across three interrelated domains of occupational health: musculoskeletal function, psychosocial well-being, and ergonomic risk. This review of 23 studies involving 1179 participants indicates that Pilates may serve as a versatile biopsychosocial intervention capable of addressing the multifactorial demands of contemporary work environments.
4.1. Physical Health and Musculoskeletal Function
Work-related musculoskeletal disorders remain a major contributor to pain, disability, and reduced productivity across both sedentary and physically demanding occupations. The present review demonstrates that Pilates interventions frequently improve core endurance, flexibility, mobility, and pain outcomes. These findings align with recent meta-analytic evidence. Lazoura et al. [ 38 ] reported clinically meaningful reductions in chronic neck pain and disability following Pilates compared with non-active controls, with benefits persisting at follow-up. Similarly, de Araujo Cazotti et al. [ 39 ] found that Pilates improves function and quality of life in individuals with mechanical neck pain and reduces analgesic use. Beyond spinal outcomes, Pilates appears to enhance systemic physical capacity; Fernández-Rodríguez et al. [ 40 ] showed that Pilates improves cardiorespiratory fitness, a key determinant of occupational fatigue.
The applicability of these benefits extends to physically demanding sectors. Perez Cunalata et al. [ 6 ] demonstrated that a 12-week Pilates program reduced pain and improved flexibility in poultry workers, suggesting relevance for ergonomically strenuous occupations. Comparable findings have been reported in agricultural settings; Kim et al. [ 7 ] observed improvements in body stability and reductions in musculoskeletal symptoms among fruit farmers following a three-month intervention. Collectively, these results support the role of Pilates as a preventive and rehabilitative strategy capable of addressing biomechanical strain across diverse occupational contexts.
4.2. Psychosocial Well-Being and Mental Health Mechanisms
Psychosocial stressors, including cognitive overload and organizational pressure, are increasingly recognized as determinants of workplace health. The present review indicates that Pilates may contribute to improvements in emotional stability, optimism, and overall quality of life, while reducing anxiety and somatization. Barbosa et al. [ 24 ] demonstrated that a nine-month Pilates program significantly reduced anxiety, depression, and fatigue among bank employees experiencing chronic organizational stress, highlighting its potential as a workplace psychosocial intervention.
When interpreting these psychosocial benefits, a sharper operational definition of the biopsychosocial construct within occupational settings is required. A clear distinction must be maintained between clinical psychiatric conditions and subclinical occupational distress. The improvements observed in anxiety, depression, and burnout scores across the reviewed literature represent shifts in subclinical psychological symptoms and subjective well-being, rather than treatments for diagnosed psychiatric disorders classified under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [ 41 , 42 , 43 ].
Emerging evidence suggests that these benefits may be driven by enhancements in positive psychological functioning rather than large reductions in clinical symptomatology. Meta-analytic findings indicate that Pilates improves quality of life, self-esteem, and vitality, consistent with the pattern observed in workplace-based studies [ 11 ]. Mechanistically, mind–body components such as attentional focus, controlled breathing, and body awareness may modulate stress-related symptoms, particularly in occupations characterized by cognitive load and postural strain.
Preliminary evidence from healthcare settings further supports this interpretation. Akyol [ 23 ] reported improvements in anxiety, vitality, and mental health among female healthcare workers following remotely delivered Pilates during the COVID-19 pandemic. Although limited by its conference-abstract format, the findings align with broader evidence showing that Pilates benefits both clinical populations [ 29 ] and healthy workers. Improvements in vitality and emotional role-functioning suggest that Pilates may influence stress regulation through interoceptive and cognitive–emotional pathways, consistent with contemporary biopsychosocial models of occupational health [ 44 , 45 ].
4.3. Ergonomics, Occupational Risk, and Implementation Models
A key strength of Pilates is its adaptability to workplace constraints. The present review supports earlier findings that Pilates can be effectively implemented in settings with limited space or time availability. Haiou et al. [ 17 ] demonstrated that chair-based Pilates improved muscle strength, balance, lumbar torque ratios, and pain in office workers compared with posture education, highlighting its feasibility as a micro-break intervention requiring minimal equipment.
For occupations involving high physical strain or psychological burnout, more intensive supervised programs may be necessary. Evidence from the COVID-19 period indicates that online and hybrid Pilates models are feasible and may yield comparable psychosocial outcomes to face-to-face delivery [ 23 , 35 ]. Meta-regression findings further support the equivalence of digital and in-person formats in general adult populations [ 11 ], suggesting that remote delivery may be suitable for dispersed or teleworking employees.
Pilates may also address cognitive–behavioral barriers to work recovery. Vera-Saura et al. [ 46 ] demonstrated that integrating mind–body cueing into Pilates reduces kinesiophobia in individuals with chronic low back pain, a factor closely linked to presenteeism and delayed return to work. However, heterogeneity in psychosocial responses across non-occupational populations underscores the importance of contextual tailoring. Occupational settings differ widely in ergonomic exposures, job demands, and organizational stressors, suggesting that Pilates may be most effective when embedded within broader ergonomic and organizational frameworks [ 11 ].
Furthermore, the synthesized data must be interpreted strictly within the context of the specific occupational cohorts evaluated, such as office workers, healthcare professionals, and manual laborers, who face distinct baseline stressors, avoiding direct extrapolation of these outcomes to the general, non-working population.
4.4. Limitations
Several limitations should be acknowledged. A critical methodological caveat of the current literature base pertains to the high occupational heterogeneity characterizing the synthesized cohorts. The included studies evaluated a diverse spectrum of professional groups, ranging from highly sedentary office personnel to high-mobility healthcare workers and manual laborers. Because baseline ergonomic exposures, daily physical demands, and caloric expenditures differ substantially between these environments, the therapeutic and preventative impact of a Pilates program cannot be uniformly extrapolated across all worker categories. Baseline job demands inevitably act as a modulating factor influencing both adherence and clinical efficacy. Consequently, the findings of this review should be interpreted with contextual caution, and future research should prioritize large-scale, industry-specific randomized controlled trials to establish optimized implementation guidelines tailored to distinct occupational risk profiles.
First, although some RCTs demonstrated low risk of bias, many quasi-experimental and observational studies exhibited moderate to serious risk due to non-randomized designs, challenges in blinding exercise interventions, and limited use of active comparators. Second, substantial heterogeneity in Pilates protocols, intervention durations, and outcome measures precluded the possibility of conducting a meta-analysis. Third, evidence directly linking Pilates to long-term economic outcomes, such as absenteeism, presenteeism, or cost–benefit indices, remains limited. Furthermore, while the physical benefits of Pilates are supported by moderate-certainty evidence, the psychological and mental health outcomes currently yield low-certainty evidence according to the GRADE assessment, primarily due to the limited number of RCTs, small sample sizes, and heterogeneous measurement tools. Finally, due to the qualitative nature of the data synthesis and the high methodological heterogeneity, a formal statistical assessment of publication bias via funnel plots was not feasible. Consequently, the presence of selective reporting cannot be entirely ruled out, and the positive trends reported herein should be interpreted with appropriate caution.
4.5. Future Directions
The aforementioned limitations identify a major research gap; future studies should prioritize high-quality randomized designs with standardized psychological metrics to clarify the impact of Pilates on workplace-related stress, burnout, and emotional well-being. Future research should prioritize standardized occupational Pilates protocols, including optimal frequency, duration, and exercise modifications for specific professional groups. Large-scale RCTs incorporating explicit cost–benefit analyses and return-on-investment metrics are needed to inform policy and support the integration of Pilates into occupational health and safety guidelines.
4.6. Practical Implications for Occupational Health
Workplace Pilates programs may offer a practical, low-cost strategy for improving musculoskeletal function and reducing stress in diverse occupational settings. The adaptability of Pilates to chair-based, on-site, or digital formats supports its integration into existing workplace wellness initiatives with minimal infrastructural demands. Organizations seeking to enhance worker health and productivity may consider incorporating structured Pilates sessions as part of broader ergonomic and psychosocial risk-management frameworks.
5. Conclusions
In summary, this systematic review suggests that the workplace application of the Pilates method may function as a potentially effective, multidimensional health-promotion approach. When viewed through a biopsychosocial lens, the modality appears to offer a balanced framework capable of addressing several of the physical and mental demands commonly encountered in modern occupational environments.
From a physical and somatic perspective, the available evidence indicates that Pilates-based interventions can contribute to reductions in work-related musculoskeletal symptoms, particularly chronic low back and neck pain, while also supporting improvements in core stability, postural alignment, and functional capacity. These effects, although not uniform across all studies, were observed with relative consistency in diverse occupational groups.
On a psychosocial level, although the certainty of evidence is generally lower, structured Pilates programs show indications of promoting positive shifts in employee well-being. Reported benefits include reductions in subclinical occupational anxiety, burnout, and perceived stress, together with improvements in job satisfaction, emotional balance, and overall vitality. These findings, however, should be interpreted cautiously given the variability in study designs and measurement tools.
Despite these encouraging trends, the substantial heterogeneity in intervention protocols, program durations, and occupational cohorts underscores the need for careful interpretation. Future research would benefit from moving toward more standardized, industry-specific randomized controlled trials capable of clarifying long-term sustainability, refining implementation strategies, and establishing clearer guidelines for integrating Pilates within occupational health frameworks.
Acknowledgments
The authors have reviewed and edited the output and take full responsibility for the content of this publication.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
Supplementary Materials
The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/healthcare14131852/s1 , Table S1: Detailed Characteristics of Included Studies; Table S2: Risk of Bias Summary for Randomized Controlled Trials (RoB 2 Tool); Table S3: Expanded GRADE Evidence Profile for Pilates Interventions in Workers.
Author Contributions
Conceptualization, I.T. (Ioannis Trigonis), I.T. (Ioannis Tsartsapakis), A.Z. and O.K.; methodology, I.T. (Ioannis Tsartsapakis), and A.Z.; software, I.T. (Ioannis Trigonis), I.T. (Ioannis Tsartsapakis) and A.Z.; validation, I.T. (Ioannis Trigonis), I.T. (Ioannis Tsartsapakis), A.Z. and O.K.; formal analysis, I.T. (Ioannis Trigonis), I.T. (Ioannis Tsartsapakis) and A.Z.; investigation, I.T. (Ioannis Trigonis), I.T. (Ioannis Tsartsapakis), A.Z., G.M. K.K., G.G. and O.K.; resources, I.T. (Ioannis Trigonis), I.T. (Ioannis Tsartsapakis) and A.Z.; investigation, I.T. (Ioannis Trigonis), I.T. (Ioannis Tsartsapakis), A.Z., G.M. K.K., G.G. and O.K.; data curation, I.T. (Ioannis Tsartsapakis), G.M. and A.Z.; writing—original draft preparation, I.T. (Ioannis Trigonis), I.T. (Ioannis Tsartsapakis) and A.Z.; writing—review and editing, I.T. (Ioannis Trigonis), I.T. (Ioannis Tsartsapakis), A.Z., G.M. K.K., G.G. and O.K.; visualization, I.T. (Ioannis Tsartsapakis); supervision, I.T. (Ioannis Trigonis), I.T. (Ioannis Tsartsapakis) and A.Z.; project administration, I.T. (Ioannis Tsartsapakis) and O.K.; funding acquisition, I.T. (Ioannis Trigonis) and O.K. All authors have read and agreed to the published version of the manuscript.
Informed Consent Statement
Not applicable.
Data Availability Statement
No new data were created or analyzed in this study.
Conflicts of Interest
The authors declare no conflicts of interest.
Abbreviations
The following abbreviations are used in this manuscript: PICOS Population, Intervention, Comparator, Outcome, Study design WMSDs/WRMSDs Work-Related Musculoskeletal Disorders CLBP Chronic Low Back Pain UCS Upper Cross Syndrome RCTs Randomized Controlled Trials ROBINS-I Risk Of Bias In Non-randomized Studies—of Interventions RoB 2 Risk of Bias 2 QALYs Quality-Adjusted Life Years VAS Visual Analogue Scale NDI Neck Disability Index ODI Oswestry Disability Index ROM Range of Motion FHA/FSA Forward Head Angle/Forward Shoulder Angle QoL Quality of Life F2F Face-to-Face Int$ International Dollars
Appendix A
Search Strategies and Syntax per Platform
PubMed (Search conducted on 30 April 2026).
Query String: ((“Pilates”[Mesh] OR “Pilates”[Title/Abstract] OR “Pilates method”[Title/Abstract] OR “Reformer Pilates”[Title/Abstract] OR “Mat Pilates”[Title/Abstract])) AND (“workplace”[Title/Abstract] OR “occupational health”[Title/Abstract] OR “corporate wellness”[Title/Abstract] OR “office workers”[Title/Abstract] OR “healthcare staff”[Title/Abstract] OR “remote workers”[Title/Abstract]) AND (“musculoskeletal”[Title/Abstract] OR “burnout”[Title/Abstract] OR “ergonomics”[Title/Abstract] OR “productivity”[Title/Abstract]).
Filters applied: None (No language or publication date restrictions were selected in the database interface to maximize sensitivity).
Yield: n = 144 records.
Scopus (Search conducted on 30 April 2026).
Query String: (TITLE-ABS-KEY(“Pilates”) OR TITLE-ABS-KEY(“Pilates method”) OR TITLE-ABS-KEY(“Reformer Pilates”) OR TITLE-ABS-KEY(“Mat Pilates”)) AND (TITLE-ABS-KEY(“workplace”) OR TITLE-ABS-KEY(“occupational health”) OR TITLE-ABS-KEY(“corporate wellness”) OR TITLE-ABS-KEY(“office workers”) OR TITLE-ABS-KEY(“healthcare staff”) OR TITLE-ABS-KEY(“remote workers”)) AND (TITLE-ABS-KEY(“musculoskeletal”) OR TITLE-ABS-KEY(“burnout”) OR TITLE-ABS-KEY(“ergonomics”) OR TITLE-ABS-KEY(“productivity”)).
Filters applied: None.
Yield: n = 211 records.
Web of Science (Meta-search Engine—Search conducted on 30 April 2026).
Query String: TS = (“Pilates” OR “Pilates method” OR “Reformer Pilates” OR “Mat Pilates”) AND TS = (“workplace” OR “occupational health” OR “corporate wellness” OR “office workers” OR “healthcare staff” OR “remote workers”) AND TS = (“musculoskeletal” OR “burnout” OR “ergonomics” OR “productivity”).
Filters applied: None (All citation indexes selected; no language filters applied).
Yield: n = 123 records.
PEDro (Physiotherapy Evidence Database—Search conducted on 30 April 2026).
Note: Due to interface limitations regarding complex Boolean operators, combinations of terms were searched individually using the advanced search fields.
Query combination examples: * Abstract & Title: Pilates AND Subdiscipline: occupational health.
Abstract & Title: Pilates AND Therapy: fitness training.
Filters applied: None.
Yield: n = 57 records.
Google Scholar (Meta-search Engine/Grey Literature Source—Search conducted on 30 April 2026).
Query String: with all of the words: Pilates | with at least one of the words: workplace “occupational health” “corporate wellness” “office workers”.
Search constraints: Sorting by relevance was applied, and the first 300 records were screened sequentially until theoretical saturation was reached (no further unique relevant studies appeared).
Yield: n = 328 records.
Note on Language Filters (Addressing Reviewer 3):
No language restriction filters were activated in any database or search engine setup. The search terms were entered in English to capture international literature indexed with English metadata (titles, abstracts, keywords). Non-English language papers identified during the screening process were eligible for translation; however, all final meeting the inclusion criteria studies were published in English.
References
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