This meta-analytical review aimed at comparing the impact of Pilates interventions (PIs) on physiological and psychological health parameters in healthy older adults and older adults with a clinical condition aged 55 years and older. The literature search was conducted in three databases (PubMed, Web of Science, SPORTDiscus). Randomized controlled trials that aimed at improving physiological and psychological health parameters in adults aged 55 years and older using Pilates as an intervention were screened for eligibility. The included data was extracted and assigned based on participants' health condition (clinical vs. non-clinical), as well as the respective control condition used in the study [inactive (IC) vs. active control group (AC)]. Statistical analyses were computed using a random-effects inverse-variance model. Fifty-one studies with a total of 2,485 participants (mean age: 66.5 ± 4.9 years) were included. Moderate effects (SMD: 0.55; 0.68) were found for physiological health parameters (muscle strength, balance, endurance, flexibility, gait, and physical functioning) in both experimental (clinical and non-clinical) conditions when compared to ICs (p < 0.003; p = 0.0001), and small to moderate effects (SMD: 0.27; 0.50) when compared to ACs (p = 0.04; p = 0.01). Moderate to large effects (SMD: 0.62; 0.83) were documented for psychological health parameters (quality of life, depression, sleep quality, fear of falling, pain, and health perception) in both conditions when compared to ICs (p < 0.001, p < 0.001). PIs induce small to large effects in physiological and psychological health parameters in older adults, regardless of their health condition. The substantial heterogeneity within the included studies complicated standardized comparison of the training modalities between the two target groups. Nonetheless, Pilates seems to be a safe, adaptable, and promising exercise approach for a heterogenous population of older adults.

<b><i>Introduction:</i></b> Declines in physical fitness can notably affect healthy aging of older adults. Multimodal exercise training regimen such as mind-body interventions (MBIs) has been reported to mitigate these aging-related declines of physical function. This meta-analytical review aimed at pooling the effects of MBIs on physical fitness indices compared to active control (AC) and inactive control (IC) conditions in healthy older adults. <b><i>Methods:</i></b> The literature search was conducted in 3 databases using search terms with Boolean conjunctions. Randomized controlled trials applying MBIs focusing on improving physical fitness parameters in healthy seniors over 65 years of age were screened for eligibility. Eligibility and study quality were assessed by 2 researchers using the PEDro scale. Standardized mean differences (SMD) adjusted for small sample sizes (Hedges’ <i>g</i>) served as main outcomes for the comparisons of MBIs versus IC and MBIs versus AC. <b><i>Results:</i></b> Thirty trials with 2,792 healthy community dwellers (mean age: 71.2 ± 4.7 years) were included. Large overall effects were found for strength (<i>p</i> &#x3c; 0.001, SMD: 0.87 [90% CI: 0.43, 1.30], <i>I</i>² = 94%), medium effects were observed for functional mobility (<i>p</i> = 0.009, SMD: 0.55 [90% CI: 0.20, 0.89], <i>I</i>² = 83%), and small overall effects were found for static balance (<i>p</i> = 0.02, SMD: 0.35 [90% CI: 0.10, 0.60], <i>I</i>² = 77%), endurance (<i>p</i> = 0.0001, SMD: 0.44 [90% CI: 0.25, 0.62], <i>I</i>² = 0%), and flexibility (<i>p</i> = 0.003, SMD: 0.46 [90% CI: 0.21, 0.72], <i>I</i>² = 54%) in favor of MBIs compared to IC. Small effects of strength slightly favoring AC (<i>p</i> = 0.08, SMD: −0.22 [90% CI: −0.43, −0.01], <i>I</i>² = 52%) were found, whereas static balance moderately improved in favor of MBIs (<i>p</i> &#x3c; 0.001, SMD: 0.46 [90% CI: 0.16, 0.76], <i>I</i>² = 73%). <b><i>Discussion/Conclusion:</i></b> MBIs induce small to moderate effects in relevant domains of physical fitness in healthy older adults. Strength should be better targeted with traditional resistance training routines, whereas balance seems to sufficiently benefit from MBIs. However, large variability between the studies was observed due to differences in methodology, intervention content, and outcomes that affect conclusive evidence.