Abstract Background: Fibromyalgia (FM) is a syndrome character-ized by chronic widespread musculoskeletal pain. The main symptoms of this disease are muscle stiffness, joint stiffness, insomnia, fatigue, mood disorders, cognitive dysfunction, anxi-ety, depression, general sensitivity and the inability to carry out normal daily activities. Aim of Study: To summarize the best evidence of the effect of Pilates based exercise training for pain and quality of life in patients with fibromyalgia. Subjects and Methods: By using electronic database: Pu-bMed, Cochrane library, Pedro and science direct. Randomized Control Trials (RCTs) were only included in this review and the others were excluded according to eligibility criteria. Results: Four RCTs were only included and were identified with good quality methodology in this review with 203 par-ticipants met the inclusion criteria, the duration of treatment was once or twice or 3 times aweek for four or eightor twelve weeks. The results showed level (1a) evidence for the effec-tiveness of Pilates based exercise training in improving pain and quality of life in patients with fibromyalgia. All included studies showed positive effects in the measured outcomes, Me-ta-analyses statistics used in this review in four studies with a high-quality assessment, and descriptive analysis in one study. Pilates based exercise training has no Significant effect in pain and quality of life in patients with fibromyalgia. Conclusion: The current study showed that, Pilates based exercise training is a safe and beneficial intervention, but has no superior effect on pain and quality of life in patients with FM compared to other traditional rehabilitation interventions. This evidence is based on a limited number of RCTs and more high-quality RCTs are needed to support this evidence.