This study explores the rehabilitation effect of pilates on middle-aged and elderly female patients with knee osteoarthritis （KOA）before and after training，develops reasonable intervention and treatment strategies for KOA patients，and provides theoretical support.31 female KOA patients were recruited and randomly divided into the experimental pilates and quadriceps training control groups. All subjects were subjected to 12-week training intervention，and their weight，lower limb muscle mass，total body muscle mass，WOMAC osteoarthritis index，VAS pain index scale，20 m timed walking test，chair standing test，step test and other physical indicators were detected and compared were measured before and after training. It was found that the bone and joint pain value，functional value，stiffness value，total value and VAS value of the experimental group showed significant changes （P <0.001），chair standing test time was significantly shortened （P <0.001），the time of 20 m timed walking test was shortened considerably （P <0.05），the number of step experiments was significantly increased （P <0.05）. The results showed that a pilates training regimen could substantially improve pain symptoms and multiple functional indicators of KOA in middle-aged and older women.