Effects of Pilates exercise on glycated hemoglobin and fasting blood sugar in type 2 diabetes: a systematic review and meta-analysis

Purpose: This systematic review and meta-analysis aimed to evaluate the effects of Pilates exercise on glycemic control-specifically glycated hemoglobin (HbA1c) and fasting blood sugar (FBS)-in patients with type 2 diabetes. Methods: Following the PICOS framework, eligible studies included: participants (P) diagnosed with type 2 diabetes; interventions (I) involving Pilates exercise regardless of type; comparisons (C) with standard diabetes care; outcomes (O) of HbA1c and FBS; and study design (S) limited to randomized controlled trials. Literature was searched in PubMed, Embase, CINAHL, Cochrane, CNKI, Wanfang, VIP Information, DBpia, KISS, RISS, and ScienceON up to April 2025. A total of 368 studies were identified, of which eight were included in the systematic review and seven in the meta-analysis. Results: Pilates exercise significantly improved glycemic outcomes compared to standard care: HbA1c (n = 275, mean difference [MD] = -0.96%; 95% confidence interval [CI]: -1.39 to -0.52; p < .001) and FBS (n = 231, MD = -23.98mg/dL; 95% CI: -35.89 to -12.07; p < .001). Conclusion: Pilates exercise may be effective as an intervention for reducing HbA1c and FBS levels in individuals with type 2 diabetes. These findings support its clinical application in diabetes management.