Background <p>Musculoskeletal disorders that follow a chronic course are associated with many symptoms, the most striking one is chronic pain that gradually worsens. The aim of this randomized controlled and single- center study was to investigate the effect of Reformer Pilates exercises on pain severity, pain coping methods, pain beliefs, fear of movement, fatigue and sleep quality in young adult patients with chronic low back pain and neck pain.</p> Methods <p>A total of 54 women aged between 30 and 50 were randomized into two groups. The Reformer Pilates (RP) group received a 6-week exercise program (45&#xa0;min/twice per week), while the control group (CG) didn’t receive any exercise program. Outcomes measured before and after the interventions were, Brief Pain Questionnaire, Pain Coping Scale, Pain Beliefs Scale, Tampa Kinesiophobia Scale, FACIT Fatigue Scale and Pittsburg Sleep Quality Index.</p> Results <p>The groups were homogeneous at baseline. Statistical differences were found in favour of RP with small to large effect size in pain parameters (<i>p</i> &lt; 0.05; Cohen’s d = 0.17–1.45), large effect size in fear of movement, small effect size in fatigue and medium effect size in sleep quality (<i>p</i> &lt; 0.05; Cohen’s d = 0.43–0.86). No statistical difference between the groups was observed only in the pain beliefs organic sub-heading of the Pain Beliefs Scale and in the passive strategies sub-headings of the Pain Coping Scale (<i>p</i> &gt; 0.05).</p> Discussion <p>The results of the current study suggest that Reformer Pilates increased active living in patients with chronic low back pain and chronic neck pain engenders a comprehensive enhancement in both physical and mental health, in addition to the capacity of patients to proactively manage their condition.</p> Trial registration <p>Registration number: NCT06706037. Date of registration: 11/25/2024.</p>