[Purpose] This study compared the effects of pilates and an exercise program on the craniovertebral angle, cervical range of motion, pain, and muscle fatigue in subjects with a forward head posture (FHP). [Subjects and Methods] A total of 28 sedentary females (age 20 to 39 years) with FHP were randomly assigned to pilates (n=14) and combined (n=14) exercise groups. The study was a randomized, controlled, double-blind study with the two groups performing exercise 50 min/day, 3 days/week, with an intensity of 11–15 rating of perceived exertion (RPE) for ten weeks. The main outcome measures were craniovertebral angle, cervical range of motion (ROM), pain levels assessed by visual analog scale (VAS), and neck disability index (NDI). Surface electromyography was also used to measure muscle fatigue. [Results] There were significant increases in craniovertebral angle and cervical ROM in the pilates group, but none in the control group. The only significant differences in muscle activity were recorded in the sternocleidomastoid muscle in the pilates group. Both exercise programs had positive effects on pain measures, as VAS and NDI were significantly decreased. [Conclusion] The results suggest that pilates could be recommended as an appropriate exercise for treatment of FHP in sedentary individuals.