© 2019 Elsevier Ltd Objective: Evidence supports benefits of exercise for mental health among people with Multiple Sclerosis (PwMS). However, non-traditional exercise modes like Pilates remain understudied. This eight-week randomized pilot trial explored indicators of feasibility of supervised or home-based Pilates compared to wait-list control on mental health outcomes among PwMS. Method: The pilot trial took place in Limerick (August to October 2017). We recruited through the MS Society of Ireland Midwest region. Seventeen females (49.8 ± 8.4 y) were randomized to two weekly 60-min supervised or home-based Pilates sessions guided by a DVD, or wait-list control. Feasibility relative to recruitment, retention, compliance, and presence/absence of adverse events was examined. Well-validated questionnaires assessed symptoms of anxiety, depression, and fatigue. Standardized mean differences and Hedges¿ d were calculated to explore magnitude of change in response to Pilates compared to wait-list. Results: Nineteen participants registered interest. Following screening, 17 met inclusion criteria and accepted randomization. Attrition was 40% for supervised Pilates; no home-based or wait-list participant withdrew. Pilates compliance was >80%. No adverse events were reported. Compared to wait-list, home-based Pilates scores were significantly lower for feelings of depressed mood at weeks 4, 6, and 8 (d = 0.47¿1.25; all p ¿ 0.02), physical symptoms of fatigue at weeks 4 and 8 (d = 0.82¿0.84; all p ¿ 0.005), and total fatigue at weeks 4 and 8 (d = 0.57¿0.60; all p ¿ 0.02). Conclusions: Findings support the feasibility of home-based Pilates to improve mental health outcomes among women with MS with minimal-to-mild mobility disability. Results support development of future larger home-based randomized controlled trials to better understand Pilates¿ effects.