33 Objectives: Chronic cardiovascular diseases, cancer, chronic respiratory diseases and diabetes 34 are the four major groups of non-communicable diseases (NCDs) and the main cause of 35 mortality worldwide. Pilates has been described as an effective intervention to promote 36 healthy behaviors and physical activity in people with chronic diseases. However, the evidence 37 of its effects in NCDs have not been systematized. We investigated the effects of Pilates in the 38 four major groups of

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... Ds. Design: A systematic review was performed. Searches were 39 conducted on Cochrane Library, EBSCO, PubMed, Science Direct, Scopus and Web of Science 40 databases. Studies were rated with the quality assessment tool for quantitative studies. As a 41 meta-analysis was not possible to conduct, a best-evidence synthesis was used. 42 Results: Twelve studies, mostly of moderate quality, were included with 491 participants 43 (78.6% females; age range 13.7-70 years old) with breast cancer (n=3), diabetes (n=3), chronic 44 stroke (2 years post stroke) (n=2), chronic obstructive pulmonary disease (n=1), cystic fibrosis 45 (n=1), heart failure (n=1) and arterial hypertension (n=1). The best-evidence synthesis 46 revealed strong evidence for improving exercise tolerance; moderate evidence for improving 47 symptoms, muscle strength and health-related quality of life and limited or conflicting 48 evidence on vital signs, metabolic parameters, body composition, respiratory function, 49 functional status, balance, flexibility and social support. 50 Conclusions: Pilates should be considered for patients with NCDs, as it improves exercise 51 tolerance. Future studies with robust methodologies are still needed to clarify its effectiveness 52 on outcomes with moderate, limited or conflicting evidence and to establish the most suitable 53 intervention protocol. 54 55 Keywords: Pilates; exercise training; complementary medicine; noncommunicable diseases 56 57 58 59 60 61 62 63 64 1. Introduction 65 Noncommunicable diseases (NCDs) are the main cause of mortality worldwide and derive in 66 substantial socioeconomic burden, entailing thousands of years lived with disability 1-3 . Chronic 67 cardiovascular diseases, cancer, chronic respiratory diseases and diabetes are the four major 68 groups of NCDs, accounting for 82% of all NCDs' deaths 4-7 . These diseases are associated with 69 modifiable risk factors, such as cigarette smoking, hypertension, dyslipidaemia, obesity, 70 physical inactivity and poor nutrition, and could be prevented or controlled by adopting a 71 healthy lifestyle 8-11 . Pilates has been described as an effective intervention to improve physical 72 activity levels and healthy behaviours, emerging as a novel intervention for the treatment of 73 chronic diseases 12 . 74 Pilates was created by Joseph Pilates in the 1920s and its philosophy relies on the tenet 75 "balance of body and mind" 13 . It is a versatile exercise that covers six principles: centring, 76 concentration, control, precision, flow and breathing 14 . Pilates has gained popularity through 77 the years for its benefits on muscle endurance, flexibility and dynamic balance in healthy 78 people 15 , and its ability to improve pain, function and kinesiophobia in people with disability 79 (e.g., patients with chronic low back pain) 16 . Moreover, recent studies suggest that this 80 intervention has potential to maximize the physical and mental health of people living with 81 NCDs 17-20 . However, the evidence of Pilates in these conditions has never been systematized. 82 Therefore, this review aimed to investigate the effects of Pilates in the four major groups of 83 NCDs -chronic cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. 84 85 2. Material and Methods 86 2.1 Study Design 87 4 This systematic review was followed the preferred reporting items for systematic 88 reviews and meta-analyses (PRISMA) guidelines 21 . The protocol was registered in the 89 international prospective register of systematic reviews (PROSPERO) (ID: CRD42016050050). 90 91 Search strategy 92 Preliminary searches were first conducted in the Cochrane Library and PROSPERO to exclude 93 the existence of a similar review. A comprehensive systematic search was then conducted in 94 the following electronic databases: Cochrane