Objectives:The aim of this study was to determine the effect of Pilates exercise on Fear of Falling (FOF) among elderly women. Methods:The present study is a clinical trial that was conducted on 44 elderly women aged between 60-80 years. Subjects were recruited through the convenience sampling method and were then randomly divided into two groups of inference viz. pilates exercise group, the members of which underwent Pilates exercise training along with the routine sanatorium exercises and the control group in which members stuck with (routine exercise only. Data was gathered by using demographic questionnaire and Fall Efficacy Scale-International (FES-I). For the intervention group, Pilates training was done for 8 weeks, three times a week (1 hour per session) under the supervision of a trained coach. Data were analyzed by the SPSS software v.16. Results:The findings indicated that the means of FES-I scores in Pilates group improved from 32.90 to 22.18 (MD=10.72) after the intervention. According to the independent t-test, there was a significant difference in the means of post intervention FES-I scores, between the two groups (P<0.001). In the Pilates group, the effect size of intervention was much more than the control group (ES=0.89). Discussion:Pilates training could decrease the FOF and may thus be implemented as an effective interventional method for fall prevention in elderly women.