Over the years, the body changes quietly but steadily: muscle strength declines, joints become less mobile and balance demands more attention. These changes are normal – and they can be influenced by training. Reformer Pilates is frequently mentioned in this context. But what does the research actually show? This article takes a measured look at the current evidence on strength, mobility and balance in later life – what is established, and what remains open.
Why strength, mobility and balance matter as we age
Whether someone remains independent in later life depends less on individual laboratory values than on very practical abilities: rising from a chair, climbing stairs safely, keeping one's balance on uneven ground. Behind these lie three physical foundations.
- Strength: In its 2019 consensus definition, the European Working Group on Sarcopenia in Older People (EWGSOP2) places muscle strength – not muscle mass alone – at the centre of age-related muscle loss. Strength is therefore a key marker of everyday function.
- Mobility: Sufficient range of motion in the hips, knees and ankles makes walking, bending and reacting to a stumble easier.
- Balance: Balance is not a fixed trait but an interplay of muscles, joint awareness, the vestibular system and attention – and can therefore be trained.
In its 2020 guidelines, the World Health Organization therefore explicitly recommends that older adults do varied multicomponent physical activity emphasising functional balance and strength training at moderate or greater intensity on three or more days a week (Bull et al., 2020). This is precisely where Pilates comes in.
What Pilates – and the reformer in particular – brings
Pilates combines controlled strengthening, conscious breathing, core stability and mobility in a single form of training. The reformer adds a sliding carriage and springs of varying strength. Three characteristics are particularly relevant for training in later life:
- Finely adjustable resistance: The springs allow the load to be adjusted in small steps – from supportive to demanding. We explain how the settings work in Understanding reformer springs & resistance.
- Training lying down and seated: Many exercises begin lying on the back or sitting. Strength and mobility can be built up before balance is additionally challenged in standing positions.
- A guided path of movement: Rails, carriage and straps provide a clear direction. At the same time, the carriage responds to every irregularity – immediate feedback that refines the sense of movement.
A tower or half-cadillac adds further points of support and exercise variations, for example for supported standing work. More on this in Reformer with or without a tower?
The evidence: what is established
There are now several systematic reviews and meta-analyses on Pilates for older adults, summarising dozens of controlled trials. The key findings at a glance:
Balance: the clearest signal
The most comprehensive recent analysis comes from de Campos Júnior and colleagues (2024, Complementary Therapies in Clinical Practice). It covers 39 studies with 1,770 participants. Compared with control groups, Pilates improved both static and dynamic balance. Compared with other forms of exercise, Pilates performed equally well – neither better nor worse. The authors rated the certainty of the evidence as very low to moderate.
A further meta-analysis by Sampaio and colleagues (2023, Healthcare) paints a similar picture: around two thirds of the programmes analysed showed a clear effect on dynamic balance.
Strength, mobility, everyday function
Fernández-Rodríguez and colleagues (2021, Physiotherapy) also analysed 39 studies of people aged 60 and over. They found moderate effects on balance, strength, flexibility and everyday function, and a large effect on measures of fall risk. Certainty of evidence was moderate for strength and fall risk and low for the other areas.
The meta-analysis by Oliveira and colleagues (2024, Journal of Bodywork and Movement Therapies), which focused specifically on strength, muscular endurance and power (24 studies, 1,190 participants aged 60 and over), is more cautious. It found an advantage for upper-limb endurance but no reliable effect on maximal strength. The authors consider the data currently too thin to recommend Pilates specifically for increasing strength.
And on the reformer?
Most studies examine mat Pilates or mix mat and apparatus work. One of the few randomised trials conducted exclusively on the reformer comes from Roller and colleagues (2018, Journal of Bodywork and Movement Therapies). 55 people aged 65 to 95 trained on the reformer in a group once a week for ten weeks. The training group improved in standard balance and mobility tests (Timed Up-and-Go, Berg Balance Scale, walking speed) and in lower-limb range of motion; the control group did not. The sample is small, but the results are notable, especially with just one session per week.
What the research does not yet tell us
An honest assessment also includes what remains open:
- Fewer falls have not been demonstrated. Better balance test results do not automatically mean fewer actual falls. In the meta-analysis by de Campos Júnior et al., Pilates did not measurably reduce either the number of falls or the fear of falling.
- Strength gains are inconsistent. Findings on maximal strength partly contradict each other. Anyone aiming to build strength benefits from progressively increased resistance – a strength of the reformer's springs that studies have so far rarely used systematically.
- Many studies are small and short. They often run for only eight to twelve weeks, with differing programmes and measurement methods. Long-term data are lacking.
- No advantage over other training. Pilates is a good option, but not a superior one. What matters is training regularly at all – and enjoying it, so that it lasts.
Our assessment: Pilates, including on the reformer, is a well-tolerated, varied form of training which, on current evidence, can above all support balance and everyday function in older adults. The reformer is a piece of training equipment, not a therapy. If you have existing complaints or conditions, a doctor or therapist decides which training is appropriate. We summarise further studies on body composition and wellbeing in Reformer Pilates: what the science really says.
What matters in training
Several practical principles can be derived from the evidence and the WHO recommendations:
- Consistency: Two to three sessions a week is a sensible goal. Combined with walks or other activity, this creates the varied weekly routine the WHO describes.
- Progression: The body adapts when demands increase gradually. On the reformer, this is achieved through spring tension, repetitions and more demanding positions – from lying to kneeling to standing.
- Building in balance deliberately: Kneeling or standing exercises on the carriage challenge balance in particular. They should follow only once the basics are secure, and initially with something to hold on to.
- Qualified instruction: Especially at the start, an experienced instructor helps choose suitable springs, positions and tempo. In the reformer study by Roller et al., too, training was instructed and took place in a group.
- Listening to your body: Control before speed, quality before quantity. Pain is not a training goal.
Reformer at home or in the studio?
For many older adults, the combination is ideal: instructed sessions in a studio or practice, complemented by calm training at home. Having your own reformer makes consistency easier – no journey, no fixed class times. Comfortable getting on and off and easily accessible spring settings are important. Our article Pilates reformer for the home summarises the key criteria; you will find an overview of the models in the reformer collection. All models are available in 28 colours.
How a reformer feels is best experienced in person. In our showrooms, you can try the equipment at your leisure and receive personal advice.
Conclusion
Strength, mobility and balance are the foundations of an independent, active life in later years – and all three can be trained. The evidence on Pilates for older adults is encouraging, particularly for balance and everyday function. For maximal strength and actual falls, it is not yet conclusive. With finely adjustable resistance, guided movement and immediate feedback, the reformer offers good conditions for training that grows with you. What matters most is to train regularly, with instruction and with enjoyment.
Frequently asked questions
Is reformer Pilates suitable for older adults?
For many, yes. The springs allow very fine dosing, and many exercises begin lying down or seated. Qualified instruction and training adapted to your individual level are important. If you have complaints or conditions, a doctor or therapist should decide beforehand.
Does Pilates improve balance?
The evidence suggests so. Several meta-analyses show improvements in static and dynamic balance in older adults compared with control groups. However, the quality of the evidence is mostly rated low to moderate.
Does Pilates reduce the risk of falling?
Pilates improves measures associated with fall risk, such as balance and walking tests. That this actually leads to fewer falls has not yet been demonstrated.
How often should you train?
The WHO recommends that older adults do activity emphasising balance and strength on three or more days a week. Two to three reformer sessions, complemented by everyday activity, is a realistic framework.
Is it ever too late to start Pilates?
No. In the study by Roller et al., participants were between 65 and 95 years old. What matters is a careful start with instruction and gradual progression.
