Introduction: Reducing the risk of falls and associated medical costs are a major global health concern in elderly populations. The aim of this systematic review is to summarize and analyze the effects of Pilates exercise training (PET) in elderly populations on fall prevention and the effects on physical fitness, mental health, quality of life and functional autonomy. Methods: Keyword “Pilates” associated with “elderly”, “aging” and “old subjects” were identified as terms for the literature research in Medline bibliographic online database, PubMed and Scopus. Only studies published in indexed and peer reviewed journals, written in the English language, were considered. The studies had to provide a PET’- intervention and age of participants had to be higher than 59 years. Results: 10 studies were identified, consisting of 6 RCTs, and 4 uncontrolled trials. Participants were mostly female, averaging 5 weeks to 12 months. Overall, PET training showed 80.2% reduction in numbers of falls, improving in static and dynamic balance, strength, walking performance, depression level, quality of life, functional autonomy and elderly population. Discussion: PET training should be considered as a way to improve quality of life of elderly, thanks to the imparted benefits of fall prevention, physical fitness, and mental health. Physicians should recommend this type of training for elderly patients since evidence has shown positive effects in several outcomes including static and dynamic balance, strength, walking performance, depression level, quality of life, functional autonomy and numbers of falls.