Balance impairment is commonly experienced in post stroke survivors. Functional retraining by conventional stroke rehabilitation program does not overcome the deficit on all kinds of stroke cases. Pilates exercise had shown positive effects in improving balance and functional activity in many elderly people. Aim of the study is to systematically review the effects of Pilates in stroke balance rehabilitation, which systematically reviewed in this study. Studies were collected from database such as Cochrane Library Trials, PubMed central, PEDro, Rehab data, Research Gate, and SAGE Journals. Inclusion criteria was randomized or quasi-randomized controlled clinical trial studies; subjects with minimum cognition level of 24-30 according to MMSE grade, and who was ambulatory. Studies with participants of any adult age with a clinical diagnosis of stroke were included. Intervention focused was therapeutic Pilates exercise aimed at improving balance. Outcomes measured were static and dynamic balance. Three RCT's were finally refined and analysis showed that "Pilates exercise is effective than conventional exercise as it showed some significant changes in improving balance in a short term". This study concludes that Pilates exercise has a positive effect on Static and dynamic balance in a stroke rehabilitation provided, an insufficient number of evidence was available to confirm it. Small numbers and heterogeneous outcomes limited the analyses, and comparisons. Further investigation is required with large number of data.