Objectives: To summarize the evidence of associations between Pilates and multiple health outcomes, and evaluate the strength and validity of these associations.Design: Unbrella review.Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to February, 2023. The methodological quality of included studies was assessed using A Measurement Tool to Assess Systematic Reviews, version 2 and the certainty of evidence was graded by the Grading of Recommendation, Assessment, Development and Evaluations. We recalculated each outcome using random-effects models with standardized mean difference.Results: We identified 27 systematic reviews with meta-analyses in this umbrella review. 1 was rated as high quality, 1 as moderate quality, 15 as low quality, and 10 as critically low quality. These studies focused on the populations with diseases of the circulatory system, endocrine, nutritional or metabolic diseases, genitourinary system diseases, mental, behavioral, or neurodevelopmental disorder, musculoskeletal system diseases, neo-plasms, nervous system diseases, sleep-wake function disorder and others. Compared with inactive/active inter-vention, Pilates can reduce body mass index and body fat percentage, relieve pain and disability, and improve sleep quality and balance. The certainty of evidence was very low to moderate for these outcomes.Conclusions: Pilates showed benefits on several health outcomes related with low back pain, neck pain and sco-liosis. However, the certainty of the evidence was mostly low; further high quality randomized controlled trials are needed to elucidate and support these promising findings.