The objective of this review was to analyze the evidence of Pilates in physical fitness related to health in the elderly. The article indexing databases (Pubmed, Medline, Science Direct, Scielo, Lilacs, and Cochrane) were reviewed along with the Pilates, elderly and aging descriptors. A total of 41 studies with a randomized experimental and quasi-experimental design met the inclusion criteria. The selection of the studies was carried out by two researchers and the quality of the articles was assessed using the PEDro scale. Interventions ranged from 4-24 weeks with 1-3 sessions/week, and balance was the most investigated variable. The studies included in this review indicate that Pilates improves health status in the elderly, promoting gains in balance, muscle strength, flexibility, functional autonomy, muscular endurance, body composition and aerobic endurance. Despite these findings, some variables need to be further investigated. Level of Evidence II; Systematic review.