Pilates uses a combination of approximately 50 simple, repetitive exercises to create muscular exertion. Advocates of this system of exercise claim that exercises can be adapted to provide either gentle strength training for rehabilitation or a strenuous workout vigorous enough to challenge skilled athletes. The exercises are designed to increase muscle strength and endurance, as well as flexibility and to improve posture and balance. There is cautious support for the effectiveness of Pilates in improving flexibility, abdominal and lumbo-pelvic stability and muscular activity. Stronger support cannot be given at this point in time primarily due to the limited number of studies and the lack of sound methodology in the published research. However, current research does indicate that there may be applications for this type of intervention in certain clinical populations that are worthy of continued investigation.