Introduction and hypothesis The purpose of this study is to determine whether a Pilates exercise program and a pelvic floor muscle-training (PFMT) program could provide similar improvements in pelvic muscle strength. Methods Sixty-two women with little or no pelvic floor dysfunction were randomized to Pilates or PFMT. Each group had 24 biweekly 1-h sessions with either a physical therapist or Pilates instructor. Strength was measured via perineometry (cmH2O). Two questionnaires-pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7)-were also collected. Results At baseline, the Pilates and PFMT groups measured 14.9±12.5 and 12.5±10.4 cmH2O, respectively (p=0.41). Both the Pilates and PFMT groups got stronger (6.2± 7.5 cmH2O, p=0.0002 and 6.6±7.4 cmH2O, p=0.0002, respectively), with no difference between groups p=0.85. PFIQ and PFDI scores improved from baseline but not between groups. Conclusions Further study is required to determine if Pilates can actually treat pelvic floor dysfunction