Introduction: The effects of exercising with the Pilates method on aspects such as balance for the general population have been reported by recent systematic reviews. However, whereas the effects of the Pilates method on improving general balance have been well studied, less is known about postural balance and the respective determinants of Pilates effects. Objectives: (1) provide more up-to-date evidence to determine the effects of Pilates on postural balance and (2) examine the effects of length of intervention, Pilates amount per week (times per week X session duration), and study quality (risk of bias) on postural balance in older adults. Methods: A systematic electronic search in Medline and Scientific Electronic Library Online (SciELO) was completed in December 2018 identifying randomized controlled trials investigating the effect of a Pilates method on postural balance in healthy older adults. A subsequent meta-analysis was performed. Results: The meta-analysis involved 6 studies and 261 individuals (128 Pilates and 133 control groups). We observed an overall effect favoring the Pilates group SMD95% = 0.89 [0.29-1.49]. The subgroup mean effects were similar for "length of intervention" (low vs high) [P = 0.557], "Pilates amount per week" (low vs high) [P = 0.565], and "study quality" (low vs high) [P = 0.869]. Conclusion: Accordingly, our findings suggest that a Pilates training program can be considered as an effective form of exercise to improve balance in older adults. Additionally, length of intervention, Pilates amount per week, and study quality were not related to the magnitude of effect on postural balance.