Pilates as therapy for multiple sclerosis: current perspective and future directions

Multiple sclerosis (MS) is a disease of the central nervous system (CNS) that often results in walking and balance impairments, fatigue, depression, and reduced quality of life (QOL). Exercise is beneficial for people with MS, and mind-body approaches like Pilates offer unique benefits, perhaps through activity-dependent neuroplasticity. The paper provides an overview of Pilates exercise as therapy in MS, and presents evidence from RCTs supporting its benefits, safety, and application in MS. We located 31 RCTs examining Pilates interventions in MS. There was consistent evidence for improvements in fatigue, balance, QOL, walking performance, mood, and select biochemical markers. However, the generalizability of the RCT evidence is limited by the predominance of studies from a single geographic region and mainly samples of young and middle-aged adults with MS, variability in intervention protocols, underrepresentation of important outcomes such as motor-cognitive function, and inconsistent reporting of adherence and safety. Overall, Pilates represents a holistic, evidence-informed approach with considerable potential for improving outcomes in people with MS, and we offer recommendations for future research on Pilates in MS.