The Effects of Three Different Pilates Methods on Pelvic Floor Muscle Function: A Randomized Comparative Interventional Study

Objective This study examined the effects of Reformer Pilates, Mat Pilates, and home-based exercise programs on pelvic floor muscle (PFM) function, as well as core and hip muscle endurance, in healthy women. Methods Forty-eight women aged 18–45 years were randomly assigned to Reformer Pilates (n = 14), Mat Pilates (n = 19), or Home Exercise (n = 15). All participants completed a 10-week program with two sessions per week. PFM strength was assessed using a Peritron™ perineometer in four positions, endurance in the hook-lying position, core endurance with McGill tests, and hip endurance with the single-leg abduction test. Results Both Reformer and Mat Pilates groups showed significant improvements across pelvic floor, core, and hip outcomes (p < 0.05), whereas no changes were observed in the Home Exercise group (p > 0.05). Reformer Pilates demonstrated the greatest gains in PFM strength (Δ = +6.50 mmHg, p < 0.001, η² = 0.691) and endurance (Δ = +6.00 s, p < 0.001, η² = 0.540). Mat Pilates also improved PFM strength (Δ = +3.63 mmHg, p < 0.001, η² = 0.406) and endurance (Δ = +2.65 s, p < 0.001). For core flexor endurance, Reformer (Δ = +16.85 s, p < 0.001, η² = 0.352) and Mat Pilates (Δ = +8.68 s, p < 0.001) produced greater improvements than Home Exercise. Hip endurance increased more in Reformer (Δ = +16.28 s, p < 0.001, η² = 0.459) and Mat Pilates (Δ = +14.52 s, p < 0.001) compared with Home Exercise. Conclusions Reformer Pilates was the most effective method for enhancing PFM function, while Mat Pilates was superior to home-based training. Both Pilates methods similarly improved core and hip endurance. Trial registration ClinicalTrials.gov, NCT07212621. Registered September 23, 2025.