🧍‍♂️ Is Reformer Pilates Worth It? What the Science Says About Its Benefits for Pain, Strength and Balance

If you've been eyeing those fancy-looking Pilates reformer machines at your local gym or studio and wondering if they're worth the hype—you're not alone.

As a GP with a special interest in midlife health, I've had more and more patients asking whether reformer Pilates could help with back pain, balance, core strength, or just staying fit as they age.

So I dug into the science. Here’s what I found—and why reformer Pilates might deserve a place in your weekly routine.

💡 What Is Reformer Pilates, Anyway?

Unlike mat Pilates (which you can do on the floor with minimal equipment), reformer Pilates uses a machine with springs, straps, and a sliding platform. It looks a bit intimidating at first, but it allows you to adjust resistance and perform smooth, controlled movements targeting different muscle groups.

The idea is to build core strength, control, flexibility, and balance—all without putting too much strain on your joints.

🏥 Back Pain Relief: Does It Help?

Back pain is one of the most common reasons people try Pilates. And there's some solid evidence that it helps—at least in the short term.

🔬 Systematic reviews and trials show that Pilates (including reformer-based routines) can:

• Reduce chronic low back pain

• Improve how well you move

• Be just as effective as other forms of exercise

• Perform better than doing nothing or minimal interventions

But here's the catch:
✅ Short-term benefits are clear
❓ Long-term results? Less well-studied

So, if you’re struggling with back pain and haven’t found relief elsewhere, a structured reformer Pilates programme could be a smart move—especially with the guidance of a trained instructor.

⚖️ Balance, Flexibility, and Core Strength

In healthy adults, reformer and mat Pilates both show benefits in:

• Flexibility

• Dynamic balance

• Muscular endurance

That means reformer Pilates can be a great option if you’re:

• Feeling stiff or less steady on your feet

• Worried about future falls or injury

• Keen to stay limber as you age

There’s even evidence from athletes suggesting that reformer Pilates may improve agility and lower limb power more than mat Pilates. So it's not just gentle movement—it can boost performance too.

🧠 Multiple Sclerosis, Trunk Strength and Neuro Rehab

If you live with a condition like multiple sclerosis (MS), you might be interested to hear that:

• Both mat and reformer Pilates improve core stability, balance, and mobility

• Reformer Pilates may offer greater trunk strength benefits

That’s promising for anyone with neurological conditions, but it also highlights something important: reformer Pilates isn't just about looking toned—it’s a serious neuromuscular workout.

💓 Is It Good for Cardio Fitness Too?

Surprisingly, yes.

Though it’s not a high-intensity sweat session, studies show that Pilates can improve your cardiovascular fitness, especially when done regularly over weeks or months. Think of it like building a better foundation for heart health through:

• Stronger muscles

• Better breathing patterns

• Improved posture and control

Not bad for something that looks so slow and graceful.

🧪 What Does the Evidence Say Overall?

Let’s be clear: the evidence for reformer Pilates is still evolving.

🔍 Here's what we know:

• Low to moderate certainty for most benefits

• Most studies are small, short-term, or use mixed Pilates formats

• Still, the trends are encouraging

The strongest evidence points to:
✅ Pain relief (especially for chronic low back pain)
✅ Improved core strength and trunk control
✅ Better balance and functional movement
✅ Physical conditioning in both healthy and clinical populations

But more high-quality, longer-term trials are needed—particularly to figure out how often, how long, and at what intensity to train for the best results.

🧍‍♂️ Reformer vs Mat Pilates: Which Is Better?

It depends on your goals.

If you enjoy using machines, like the feel of guided resistance, or want to target strength and coordination, reformer Pilates might be worth the investment.

🙋‍♂️ My Take – And What I Recommend

Personally, I love how reformer Pilates can blend strength, control, and flexibility in a way that’s kind to the joints. For many of my patients—especially those in midlife juggling work, family, and the first signs of aches and stiffness—it offers an efficient way to move better and feel better.

It’s not a miracle cure. But it ticks a lot of boxes: low injury risk, whole-body engagement, core stability, and gentle progression. And if you’ve got a good local instructor or class, it can even be fun.

🧭 Want to Try It?

✅ Start with a beginner reformer class, ideally one-on-one or in a small group
✅ Check the instructor’s qualifications and experience
✅ If you have a condition like back pain or MS, let them know in advance
✅ Expect to feel muscles you didn’t know you had

And remember: consistency is key. Most benefits come after 8–12 weeks of regular practice.

📚 References

• Pilates for Low Back Pain: Complete Republication of a Cochrane Review. Yamato TP, Maher CG, Saragiotto BT, et al. Spine. 2016;41(12):1013-1021. doi:10.1097/BRS.0000000000001398.
• The Effectiveness of Pilates Exercise in People With Chronic Low Back Pain: A Systematic Review. Wells C, Kolt GS, Marshall P, Hill B, Bialocerkowski A. PloS One. 2014;9(7):e100402. doi:10.1371/journal.pone.0100402.
• Efficacy of Pilates on Pain, Functional Disorders and Quality of Life in Patients With Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Yu Z, Yin Y, Wang J, et al. International Journal of Environmental Research and Public Health. 2023;20(4):2850. doi:10.3390/ijerph20042850.
• Pilates and Multiple Health Outcomes: An Umbrella Review. Xu M, Tian C, Wang Y, et al. Journal of Science and Medicine in Sport. 2023 Apr-May;26(4-5):232-240. doi:10.1016/j.jsams.2023.03.011.
• A Systematic Review of the Effects of Pilates Method of Exercise in Healthy People. Cruz-Ferreira A, Fernandes J, Laranjo L, Bernardo LM, Silva A. Archives of Physical Medicine and Rehabilitation. 2011;92(12):2071-81. doi:10.1016/j.apmr.2011.06.018.
• Effect of the Pilates Method on Physical Conditioning of Healthy Subjects: A Systematic Review and Meta-Analysis. Campos RR, Dias JM, Pereira LM, et al. The Journal of Sports Medicine and Physical Fitness. 2016 Jul-Aug;56(7-8):864-73.
• Randomised Controlled Study on the Effects of Pilates Exercises in Soccer: Comparing Mat and Reformer Methods on Physical and Technical Performance. Yılmaz O, Kaplan T, Batalik L. PloS One. 2025;20(5):e0324129. doi:10.1371/journal.pone.0324129.
• The Effects of Mat Pilates and Reformer Pilates in Patients With Multiple Sclerosis: A Randomized Controlled Study. Bulguroglu I, Guclu-Gunduz A, Yazici G, et al. NeuroRehabilitation. 2017;41(2):413-422. doi:10.3233/NRE-162121.
• The Relationship of Trunk Muscle Activation and Core Stability: A Biomechanical Analysis of Pilates-Based Stabilization Exercise. Lee K. International Journal of Environmental Research and Public Health. 2021;18(23):12804. doi:10.3390/ijerph182312804.
• Pilates Method Improves Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis. Fernández-Rodríguez R, Álvarez-Bueno C, Ferri-Morales A, et al. Journal of Clinical Medicine. 2019;8(11):E1761. doi:10.3390/jcm8111761.